The South African Medical Association (Sama) and the Council for Medical Schemes are to square off at the Competition Tribunal on Tuesday in their long-running row over how specialists bill patients. The outcome of the case is important because it may affect how medical schemes reimburse members. Sama is the country’s biggest doctor organisation and has members employed by the public and private sector. The council is a statutory body that is responsible for regulating the medical schemes industry and protecting consumers’ interests. The council is alleging the South African Paediatric Association and the Society for Cardiothoracic Surgeons in SA have engaged in price-fixing with Sama, breaching the Competition Act. Both associations are Sama members. The council alleges Sama has engaged in a prohibited horizontal practice by endorsing the billing practices of these associations, which use extra billing codes not included in the National Health Reference Price List (NHRPL) published...
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