Medical scheme access to clinical records

In terms of Regulation 15J(2)© of the Medical Schemes Act Regulations, a medical scheme is entitled to access any treatment record held by a managed health care organisation or health care provider and other information pertaining to the diagnosis, treatment and health status of the beneficiary in terms of a contract entered into pursuant to […]

Prosecution for fraudulent activities

Section 16 of the Medical Schemes Act places an obligation on Council for Medical Schemes to report cases of improper or disgraceful conduct (Unprofessional Conduct) to a medical scheme by practitioners registered with HPCSA to the HPCSA as the statutory body which has jurisdiction over practitioners registered under the Health Professions Act. Where a criminal […]

Recovery of ill-gotten benefits from practitioners

Section 59(3) of the Medical Schemes Act empowers the medical scheme to recover any amount which has been paid bona fide to which a practitioner is not entitled to or any loss which has been sustained by the medical scheme through theft, fraud, negligence or any misconduct which comes to the notice of the medical […]

Legal status of scheme payment arrangements

The payment arrangements between practitioners and medical schemes are legally binding if they are lawful. Medical schemes are duty bound in terms of common law and section 66 of the Medical Schemes Act to report unprofessional conduct to the HPCSA. Guidance provided here is not exhaustive and practitioners are advised to approach Council for further […]

Withholding of claims due to practitioners by medical schemes

In terms of Section 59(2) of the Medical Schemes Act, the scheme should pay a claim either to the member or practitioner within 30 days of receiving the claim. According to Regulation 6 of the Medical Schemes Act Regulations, if a medical scheme is of the opinion that an account, statement or claim is erroneous […]

Emergency vehicle transport guidelines

Emergency Medical and Rescue Vehicles responding to cases involving patients and/or potential patients should be staffed by suitably qualified individuals duly registered with the Health Professions Council of South Africa within the relevant category registerable under the Health Professions Act, 1974 (Act 56 of 1974). It is permissible for unregistered persons such as firefighters, allied […]

Treatment guidelines of ill and injured

Patients have a right to an appropriate continuum of care. This continuum of care begins within the prehospital environment and extends right through to patient discharge and follow-up. In the emergency care domain, there are various levels of care that can be initiated depending on the patient’s injury/illness. These various levels of care are related […]

Social media and the use of technology in EMS

Patients have a right to dignity, privacy and confidentiality. This is enshrined in the Constitution of the Republic of South Africa and must always be respected. Emergency Care Providers are reminded that the taking of photographs and/or recording of video and/or audio footage and/or subsequent dissemination (either via personal communication or social media) of incidents […]

New regulations for BAAs, AEAs and OECOs

The regulations relating to the qualifications for the registration of Basic Ambulance Assistants (BAAs), Ambulance Emergency Assistants (AEAs), Paramedics and Operational Emergency Care Orderlies (OECOs) have reference. This letter serves as a reminder that as from 1 February 2018 the BAA, OECO and Paramedic (CCA) qualifications will no longer entitle a person to registration with […]