The Independent Practitioner Association Foundation of South Africa (IPAF), in a firmly worded position statement* on fraud and alleged racism by medical schemes just released, has come out strongly against medical schemes forensic units’ “disregard for the law and due process” when investigating fraud claims.

IPAF is a national network of more than 5000 family practitioners (FP/GP) nationally,  representing SP Net, ASAIPA, NHC, and the SAMCC including KZNDHC, GMCC and CPC Qualicare.

“We accept the fact that members’ funds,” the statement acknowledges, “have to be protected and the schemes and administrators have to ensure that fraud is eliminated in the industry. However, what has been brought to our attention, as IPAF, is the disregard for the law and due process when investigating fraud. There are no set operational standards by which these units operate. There are no standards of minimum qualification or accreditation of these units, or their officers.

“Their only function,” IPAF adds, “is to recoup monies at all cost. In the process doctors’ rights and patient confidentiality is trampled on. There is no authority body that overlooks their function. They are a law unto themselves.”

It goes on to point out that the Health Professional Council of SA (HPCSA) has repeatedly requested that any doctor found to have behaved unethically or guilty of any fraudulent behaviour that brings the profession into disrepute should be reported to them to take disciplinary action: “These units do not do this; rather they suggest non-disclosure and use that as leverage to coerce the doctor into signing an Acknowledgment Of Debt (AOD).”

This in itself, the AOD practice, was another problem faced by practitioners as IPAF points out: “The amounts computed in these AODs are usually based upon small samples of evidence, which is irregularly assembled, unscientifically computed and frequently a thumb suck on the part of the funder who alleges that they have been defrauded. The doctor, for his part is intimidated by the process, is ill equipped to represent himself and to challenge or test the validity of the allegations, and is threatened by adverse publicity and reporting to the HPCSA and SAPS should he resist signing the AOD.

“IPAF condemns the practice of signing AODs. Criminal matters have to be reported to the SAPS and unethical matters should be reported to the HPCSA.”

*The full IPAF Position Statement can be accessed at

https://docs.google.com/document/d/1lsTiEjkwCa9G3XSESCz0JPcj2xFlnpzh_2AuVu1gN2A/edit#