Assocation news: Abuse of prescribed minimum benefits

“It has come to our attention that a few practitioners appear to be abusing the Prescribed Minimum Benefits regime by charging patients (and therefore their medical schemes) at the highest HPCSA ethical ceiling tariff, knowing fully well that medical schemes are obliged by law to honour claims at this level of benefits,” says HPCSA Registrar, Adv. Boyce Mkhize. “This is disingenuous and we will not hesitate to act if such practices are found to be true.”

“We wish to reiterate once again that the HPCSA ethical tariff is not the yardstick upon which billing practices should be based but rather a ceiling to guide the HPCSA in determining whether or not a practitioner could be said to have over-charged a patient.”

The Registrar confirmed Council's previous statements that practitioners may charge up to this tariff on condition that they obtain prior and informed patient consent whenever they intend to charge above the rate at which the medical schemes normally reimburse their clients.

“The HPCSA has reason to be concerned if the healthcare compensation systems are abused to the detriment of the patient as may be evidenced by the ever escalating healthcare costs. We therefore urge practitioners to ensure that they charge at the HPCSA ethical tariff ceiling ONLY with the informed consent of the patient, even in cases of Prescribed Minimum Benefits.

“Should we establish that practitioners abuse the system, for instance where they would charge a medical aid rate for other procedures or category of benefits and change their billing when it comes to Prescribed Minimum Benefits, we would not hesitate to take appropriate disciplinary measures,” he warned.

553 Vermeulen Street
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PO Box 205
Pretoria, 0001

Tel: +27 (12) 338 9481
Fax: +27 (12) 324 5726
Email: greervz@hpcsa.co.za
Website: www.hpcsa.co.za