Guiding consumers since 2009

Medical aid: CMS told to consolidate case against SAMA

By Jessica Anne Wood

The Council for Medical Scheme (CMS) has been ordered by the Competition Tribunal to submit further particulars and consolidate its case against the South African Medical Council (SAMA).

In 2013, the CMS filed a complaint with the Competition Commission alleging that in 2009, medical tariffs determined by SAMA allowed paediatricians to bill an extra 50% above the medical aid rate payable for new born babies requiring intensive care.

The CMS lodged a second complaint that same year regarding the 2010 billing guidelines of the Society for Cardiothoracic Surgeons of South Africa (SOCTSA).

According to the Tribunal, the CMS alleged that for both cases the application of these tariffs were prohibited under the Competition Act.

The latest decision

The Tribunal has now given the CMS 20 business days to consolidate its pleadings with regards to both complaints it lodged in 2013 against SAMA and two other organisations for price fixing. At the same time, the Tribunal has dismissed SAMA’s application to have the complaints dismissed. In a statement the Tribunal clarified that the CMS is required to provide the particularity sought by SAMA in relation to its complaint against SAMA.

Furthermore, the Tribunal has tasked the CMS with elaborating “on the recommendation and the binding nature of SAMA’s publication, and why it’s important for SAMA to publish these guidelines and how SAMA is able to achieve compliance with these guidelines by the paediatricians/ neonatologists. CMS needs to outline what mechanisms, if any, are utilised by SAMA to punish non-compliance. And that the CMS must amend its complaint limiting it only to the complaint by Dr Botha, a cardiothoracic surgeon who performed a coronary artery bypass surgery on a patient who was a member of PROFMED Medical Scheme.”

In explaining its decision, the Tribunal said: “The (2013) referrals have obviously evolved overtime and such evolution has given rise to confusions and contradictions between all the various affidavits CMS has filed.”

As the case is still in progress, the CMS was unable to offer commentary.

 Handy tip: To get a competitive medical aid quote, click here

Recent Articles

Featured Are you entitled to your spouse’s pension after divorce?

Divorce means more than just parting ways with your partner. It may also involve parting ways with your assets. The Divorce Act states that your retirement fund forms part of your assets. This means that it will be considered when dividing up your assets.

Retrenched – what payments are you entitled to?

In the current struggling economic climate, retrenchments are a regular occurrence and not everyone survives the cut. If you find yourself on the receiving end of retrenchment you may have questions about the payments that are due to you.

Do you want to settle your debt?

You may be considering settling your credit account, whether it’s a credit card or various store accounts, now may be as good a time as any. This especially if you have saved, or you received a tax return or salary bonus. 

Can you afford a personal loan?

Taking out new debt is not always a choice. However, if you’re not pressed by a medical emergency or an unforeseen disaster, it’s worthwhile considering whether you can actually afford it. But what does it mean to “be able to afford a personal loan”? What percentage of your income should you not exceed dedicating to it? 

Deals

Eat for less on Tuesdays at Panarotti’s

Price: R59.99
When: Tuesdays
Where: Nationwide

Get discounts with Clicks ClubCard Seniors Programme

Price: Available on request
When: Daily
Where: Nationwide

Amani Spa Voucher Special

Price: R1000
When: Daily
Where: Cape Town, Jhb, and Port Elizabeth