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BUSINESS DAY The Council for Medical Schemes CMS in 2018 inexplicably terminated a two year investigation into allegations of trustee election fraud, improper contracts and conflicts of interest at Bonitas Medical Fund, SA's second largest open medical scheme. The CMS initiated the investigation, which is called an "inspection" in terms of the Medical Schemes Act, into Bonitas in November 2014. Bonitas then launched legal action opposing the inspection that went as far as the Supreme Court of Appeal. The inspection eventually got under way in late 2016, before being halted. Business Day has seen a draft inspection report into the affairs of Bonitas, compiled by independent investigator Dennis Mayaba. He was prematurely pulled from the job. Bonitas last week threatened to interdict Business Day from publishing aspects of the draft inspection report. The newspaper has agreed not to publish allegations levelled against Bonitas at this stage, as it is incomplete, by the inspector's admission. However, Business Day can reveal that in his report Mayaba says he faced "significant challenges in obtaining cooperation, support and information from certain representatives of the CMS" during the course of his inspection, and that he was instructed to stop working on the probe before it was complete. He was unable to interview Bonitas employees, executives and trustees. Mayaba submitted a draft report to the CMS on October 12 2018, drawing attention to the premature termination of his work. "It is disconcerting that there seems to be an orchestrated effort by certain individuals at the regulator to derail the processes described in the Act," wrote Mayaba, referring to the Medical Schemes Act He declined to comment when approached, referring queries to the CMS. The CMS is charged with safeguarding consumers' interests and ensuring schemes play by the rules, but its unexplained halting of a CMS mum over Bonitas on such serious allegations raises questions about the nature of the regulator's relationship with the 11180bn industry it oversees. Bonitas has 720,000 beneficiaries and is administered by Medscheme, which is owned by a subsidiary of JSE listed Afro centric Group. Earlier in 2019, the CMS sus pended Stephen Mmatli, the head of investigations and compliance, pending the outcome of an inquiry into alleged corruption on his part. The CMS also faces a probe by the Special Investigating Unit, which awaits a proclamation from the president before it gets under way. The CMS confirmed that it had received Mayaba's draft report, but declined to explain why the inspection had been aborted, or indicate who gave the instruction to do so. When asked what action it had taken in response to Mayaba's claim levelled four months ago that his work had effectively been interfered with by the CMS, spokesperson Grace Khoza said: “The report is currently being processed internally and we cannot respond to this question at this time.” Bonitas principal officer Gerhard van Emmenis said the scheme had received the draft report from the CMS on January 14 but had yet to formulate its response to the regulator. He said he was aware the inspec tion had been prematurely terminated but did not know why. "We have directed an enquiry to the regulator, but have not yet heard back," Van Emmenis said. Bonitas has a solvency ratio of 25%, and reported a surplus of R730.2m in 2017, indicating it is in strong financial health, according to a statement issued by the scheme two weeks ago. A scheme's solvency ratio is the ratio of accumulated funds to annualised gross contributions, and is required by the Medical Schemes Act to be at least 25%.
Created at 2019/03/05 11:09 AM by Mediclinic
Last modified at 2019/03/05 11:09 AM by Mediclinic