News

CMS to implement universal, legally binding code of conduct

27 Mar 2026

The Council for Medical Schemes (CMS) has committed to implementing recommendations from the Section 59 Investigation into alleged discrimination against black healthcare providers. – Business Day (26 March 2026)
The probe, launched after complaints of unfair targeting in fraud audits, found black providers were more frequently singled out but uncovered no evidence of race-based selection, noting that practice numbers do not reveal racial information.
The CMS now plans a universal, legally binding code of conduct to standardise fraud investigations. Circular 10 of 2026 outlines immediate directives, stressing that audit, recovery and payment processes must not discriminate directly or indirectly. Schemes are instructed to review methodologies, notify providers earlier when anomalies arise and consider potential hardship when recovering funds, aiming to improve transparency and trust.
Meanwhile, MPs pressed CMS on delays in implementing Health Market Inquiry recommendations. Draft regulations proposing collective tariff negotiations, gazetted in February 2025, remain under review following public feedback.

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