By Paidamoyo Chipunza
Government is considering approaching the Attorney-General’s Office for legal advice over the unending fight between Corporate 24 — a health service provider and Cimas Medical Aid society following continued defiance on standing regulations on health insurance by the later.
Health and Child Care Secretary Major- General Dr Gerald Gwinji (Retired) said Government as the regulator of medical aid societies had taken an administrative role based on standing statutes by ordering Cimas to let its members intending to get treatment from Corporate 24 do so using the medical aid card.
However, Cimas publicly refused to comply with the directive advising its members intending to get treatment from Corporate 24 to pay cash instead and claim for reimbursement from the society defying the purpose of health insurance.
“We had said in our communication, the way to proceed is for Cimas not to pay for the disputed claims until the matter is finalised, but at the same time they must not continue blocking access by patients. That is the bit we were interested in and had asked for,” said Dr Gwinji.
He said Cimas refused to comply arguing that the two warring parties still had cases pending at the courts. Dr Gwinji said when Government made the directive it had been informed that the same court cases had been withdrawn.
“It seemed as if the case had been withdrawn, put back in courts and so forth. Now the only recourse that I have is to consult the Attorney-General and this is exactly what I am doing, giving them the necessary documents, so that they then give us legal guidance as to how we can proceed because the administrative route has not worked,” said Dr Gwinji.
He said the administrative route was failing to work because warring parties continue to cite technicalities each time the discussion is brought up and this has happened a number of times. Dr Gwinji said current regulations on health insurance were weak to effectively regulate the industry, hence, the need to revise current laws on health insurance.
“With the current laws most of the obligations seem to be on the practitioner, while the statutes are supposed to regulate the industry of medical aid so that is a huge shortfall in the SI,” said Dr Gwinji.
Government is in the process of coming up with a medical aid societies Act that is expected to see better regulation of the health insurance industry.
The fight between Cimas and Corporate 24 dates back to 2015 when Cimas instituted a forensic audit on claims submitted by Corporate 24 after suspecting that some claims could have been fraudulent. But Corporate 24 insisted that no claims were raised fraudulently, in fact some of the claims had genuine errors common in health service provision.
However, since then Cimas has been ordering its members intending to seek medical services from Corporate 24 to pay cash then claim for a reimbursement after receiving treatment. The Herald