Medical practitioners accuse Discovery of unethical conduct

 

Medical practitioners are accusing Discovery Health of forcing them to hand over clinical notes and intimidating them into paying debt that has long prescribed, reported Business Maverick (13 June 2021)

  • A medical aid fund must, in accordance with the Medical Schemes Act (MSA), query or dispute a claim within 30 days from the date of lodging, by providing written notice to both the fund member and the healthcare provider. The latter then has 60 days within which to respond and rectify the claim. If the scheme does not notify either party within 30 days that a claim is erroneous, or fails to allow correction and resubmission, the onus is on the scheme to prove the error.

“Discovery has exceeded these time limits, by far. Some treatments were pre-authorised, accepted and paid after the procedure, while others were authorised and paid once the procedure was performed. “Discovery does not deny that it enforces clawbacks, claiming it is legally entitled to do so to protect the scheme’s income.

https://www.dailymaverick.co.za/article/2021-06-13-medical-practitioners-lambast-discovery-health-for-unethical-irregular-clawbacks/

 

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