An industry-wide probe into allegations of fraud and corruption, as well as a constrained budget, are just two of the challenges the Council for Medical Schemes is facing. According to a Fin24 report, officials from the council have briefed Parliament's portfolio committee on health on its annual performance plan and budget.
Registrar Dr Sipho Kabane told the committee that the CMS had invited the Special Investigating Unit (SIU) to conduct an industry-wide probe into allegations of fraud and corruption, which have stemmed from a previous investigation into the council's GM of compliance, Stephen Mmatli. In the meantime, the SIU had received a proclamation from President Cyril Ramaphosa and has started its investigation, Kabane said. The CMS is working along with the SIU on the investigation to rid the industry of "fraud and corruption," he said.
The report says the CMS has also appointed an investigation panel led by Advocate Tembeka Ngcukaitobi to look into allegations of racial profiling by medical schemes.
The CMS is also challenged by a lack of resources. The CMS has a personnel of 120 individuals in comparison to the 8.9m medical scheme beneficiaries whose interests the council aims to protect. Kabane also said in light of the investigations, the CMS's mandate is expanding – specifically to tackle fraud and corruption, which has warranted a need for restructuring of the organisation so that it can be fit for its purpose. The CMS's budget is R164.9m, which is small relative to the size of the industry it is regulating, CFO Daniel Lehutjo is quoted in the report as saying.
[link url="https://www.fin24.com/Companies/Health/council-for-medical-schemes-hit-by-probes-lack-of-funding-staff-shortages-20190829"]Fin24 report[/link]