COMPETITION TRIBUNAL
Medical scheme body told to give more details on specialists’ billing
The Competition Tribunal has ordered the Council for Medical Schemes (CMS) to submit further details and consolidate its case against the South African Medical Association (Sama) in a long battle over how specialists bill patients. The matter potentially has far-reaching implications for the way medical schemes reimburse patients, as Sama is the biggest doctor organisation and holds sway across the industry. The CMS is a statutory body that regulates the medical schemes industry and safeguards consumers’ interests. The dispute between the parties dates back to 2013 and centres on the CMS’s allegation that Sama has engaged in a prohibited horizontal practice by endorsing the billing practices of the South African Pediatric Association (Sapa) and the Society for Cardiothoracic Surgeons in SA (SOCTSA), thus breaching the Competition Act. These associations use extra billing codes that are not included in the National Health Reference Price List (NHRPL), published by the CMS more than 1...
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