NATIONAL ASSEMBLY

FOR WRITTEN REPLY
QUESTION NO. 3463

DATE OF PUBLICATION IN INTERNAL QUESTION PAPER: 11 NOVEMBER 2011  

(INTERNAL QUESTION PAPER NO. 38)

Mr M Waters (DA) to ask the Minister of Health:

(1) Whether the Council of Medical Schemes (CMS) decided to investigate a certain medical scheme (name furnished); if so, (a) on what date was the decision taken, (b) when was the registrar informed of such a decision and (c) on what dates did the chairperson of the CMS and the registrar receive communication from the chairperson of the Portfolio Committee on Health;

(2) whether the (a) chairperson of the CMS, (b) registrar and (c) Chairperson of the Portfolio Committee on Health met at (i) OR Tambo International Airport or (ii) any other venue to discuss the investigation into the specified medical scheme; if so, in each case, (aa) on what date, (bb) at what venue, (cc) what was the purpose of the meeting and (dd) who else attended the meeting?

NW4080E

REPLY:

(1) (a) and (b) The Registrar instituted an investigation into Medshield on 09 February 2011. The Inspectors appointed for this assignment were Ernst & Young Advisory services Ltd, with Adv. James de Villiers acting as the lead inspector. The inspection could not be completed due to the misunderstanding on the terms of reference between the scheme and the CMS thus leading to the scheme's refusal to grant the inspectors access to the premises of the scheme.

(c)  The Registrar and the chairperson of the CMS received communication on 6 June 2011 from the Chairperson of the Portfolio Committee on Health. This communication referred to a complaint by Medshield to Chairperson of the Portfolio Committee on Health about abuse of authority/power by the Council for Medical Schemes. The Chairperson of the Portfolio Committee on Health sought to mediate between the parties on the terms of reference for the inspection.

Both parties could not reach agreement and CMS further resolved that the Chairperson and the Registrar meet the Chairperson of the Portfolio Committee on Health to inform him that CMS would no longer participate in the mediation initiatives between the scheme and CMS.The scheme apparently complained again to the Chairperson of the Portfolio Committee on Health that the CMS is abusing its power and the Chairperson of the Portfolio Committee on Health wrote to the Chair of Council and the Registrar on 11 October 2011 communicating those sentiments and requested that the matter be resolved. The Council then resolved on 27 October 2011 that the inspection proceed without any further delay. This resolution was actioned by the Registrar on 2 November 2011.

(2) The Chairperson of the CMS, the Registrar of the CMS and Chairperson of the Portfolio Committee on Health met  on 22 June 2011 at Southern Sun, OR Tambo International Airport to discuss  the scheme's complaint about the terms of reference for the CMS inspection into Medshield Medical Scheme and to explore possible alternative dispute resolution. The following persons attended:

(i) Dr. B  Goqwana-Chairperson of the Portfolio Committee on Health;

(ii) Dr. M Gantsho-Registrar of the Council for Medical schemes;

(iii) Prof. W Pick-Chairperson of the Council for Medical Schemes;

(iv) Mr. S Mmatli-Head: Compliance & Investigations -Council for Medical Schemes;

(v) Mr. C Burton-Durham-Head: Legal Services-Council for medical Schemes

Medshield Medical Scheme

(i) Mr. T Mabeta- Chairperson of the Board of Medshield;

(ii) Ms. P Moiloa-Board member for Medshield;

(iii) Mr. B Sermony-Board member for Medshield;

(iv) Dr. M Wright-Board member for Medshield;

(v) Adv M. Hellens SC-Counsel for Medshield;

(vi) Adv. A Bezuidenhout-Counsel for Medshield;

(vii) Mr. M Versfeld-Attorney for Medshield;

(viii) Mr. M Tlali-Attorney for Medshield

Issued by Parliament, December 1 2011

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