Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

GEMS to closely review Section 59 Investigation Preliminary Report findings

20 January 2021 Government Employees Medical Scheme (GEMS)

The Government Employees Medical Scheme (GEMS) has noted the release of the Section 59 Investigation Preliminary Report which investigated the veracity of allegations made by medical professionals that they were being discriminated against by medical schemes and administrators and their claims were being withheld based on their race and ethnicity.

The Scheme has always supported the establishment of the Section 59 Investigation by the Council for Medical Schemes (CMS) and continue to do so.

Commenting on the release of the preliminary report findings to the public, Dr Stanley Moloabi, Principal Officer of GEMS said, “GEMS has noted with concern the preliminary findings, and as the Panel has afforded impacted Schemes a period of six weeks to study the report and thereafter provide formal comments based on the interim findings; GEMS will take this opportunity to closely study the full report findings, and the recommendations of the Panel to establish a way forward.”

Providing clarity on the interdict application made by the Board of Healthcare Funders (BHF) and GEMS, Dr Moloabi clarifies, “Our intention was never to ‘block’ the release of the report, but to request that due processes be followed in ensuring that affected parties had a view of the report before it was released to the public.”

“GEMS has a zero-tolerance to all forms of discrimination and pledges to implement corrective action where such remedial interventions are required and as recommended by the Panel for the benefit of our members and healthcare providers,” Dr Moloabi commented.

The task at hand is to engage widely with healthcare providers to strengthen relationships with them and make sure that if there are any loopholes, we work together to fix them for the benefit of all.

“GEMS has nothing to hide and have throughout the process cooperated with the Panel to support in providing all information required for the panel to meet its obligations.

“GEMS will continue in all efforts to ensure that medical professionals receive their claims payments as the Scheme has been doing, in line with scheme rules and provisions of the Medical Schemes Act. GEMS remains committed to eradicate fraud, waste and abuse to ensure we sustain the Scheme financially for the benefit of our members, the same way we are committed to ensuring that there is no unfair racial discrimination whether deemed to be intentional or due to flawed processes that we were blinded to,” concluded Dr Moloabi.


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