Department of Health declares certain DSP practices by medical schemes irregular
Certain practices by medical schemes in selecting Designated Health Care Providers (DSPs), as well as imposing excessive co-payments on members, have been declared an irregular and undesirable practice by the Department of Health (in Terms of Section 61 of the Medical Schemes Act No131 of 1998 )
A notice to this effect was published in the Government Gazette (23 April 2021)
This follows information provided by the CMS regarding the way in which some medical schemes: Unilaterally and without restriction, determine the criteria to apply when selecting their DSPs;
Select DSPs without engaging in a fair procurement process;
Unfairly limits the number of selected service providers (including pharmacies) available to provide healthcare services to the members; and
Oblige members to use only the selected limited number of DSPs or risk paying exorbitant co-payments.