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 scheme. In such instances schemes may recover funds as follows:

  1. By deducting such amount from any benefit payable to the health practitioner. Council advises practitioners that the agreements they reach with the medical schemes should be as prescribed in terms of this section of the Medical Schemes Act. OR
  2. Through any other lawful arrangement made with a practitioner to refund the scheme.

Guidance provided here is not exhaustive and practitioners are advised to approach Council for further advice by directing an e-mail to Professionalpractice@hpcsa.co.za  for guidance on ethico-legal matters. 

Council commits to a turnaround time of 10 working days to respond to any request for advice and/or guidance through the e-mail provided above.