Physios’ bid to halt clawbacks may have devastating effects

The SA Society of Physiotherapy’s (SASPs) bid to the Pretoria High Court to scrap provisions in the Medical Schemes Act that enable schemes to recover claims paid in error will have a devastating effect on the industry if it is upheld by the courts, according to a legal consultant to the Board of Healthcare Funders (BHF) Business Day (28 October 2021)

SASP is asking the court to declare section 59 (3) of the act unconstitutional and wants the power to decide on claim disputes between schemes and healthcare providers to be given to an independent party, and a review of six years of contested audits.
“If Section 59 (3) is done away with, then schemes would have to take longer than 30 days to process claims, because the level of scrutiny would have to be increased dramatically just for ordinary claims,” according to Debbie Perlman, BHF's legal advisor.

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