A new study by the University of Pretoria (UP) has uncovered serious concerns about the way medical schemes conduct forensic audits on physiotherapists, warning that the process is often harmful, coercive and lacking accountability.

UP on Tuesday, told the media that the research, led by Lesley Meyer from the University’s Department of Physiotherapy, highlights how audits meant to safeguard funds are instead leaving practitioners traumatised, financially strained and professionally stigmatised, often without proof of wrongdoing.

Forensic audits are designed to detect billing irregularities and protect members’ contributions. But Meyer’s study, published in the South African Journal of Physiotherapy, found that in practice these audits frequently go beyond their legal limits and fail to follow fair procedures.

Under the Medical Schemes Act of 1998, medical schemes are allowed to investigate suspicious claims. However, cases involving alleged fraud above R100 000 are supposed to be referred to external authorities such as the Health Professions Council of South Africa (HPCSA) or the South African Police Service (SAPS).

Instead, the study found that schemes often bypass this requirement by reclassifying suspected fraud as administrative errors. This allows them to conduct internal investigations without oversight, a loophole Meyer says has enabled coercive practices and abuse of power.

Participants in the study described the audits as punitive rather than corrective. Many reported feeling targeted and treated as suspects from the outset.

“Participants reported feeling unfairly singled out, describing the audit process as a witch hunt,” Meyer said.

Physiotherapists interviewed said they were frequently denied access to evidence used against them, leaving them unable to defend themselves. In several cases, practitioners were pressured to sign Admissions of Debt (AODs) to avoid prolonged disputes or financial collapse.

These payments ranged from R54 000 for small practices to as much as R4.5 million for larger group practices.

According to the study, refusal to sign often resulted in medical schemes blocking payments, effectively forcing practices to operate on a cash-only basis. This, in turn, led to some being blacklisted, further damaging their reputations and livelihoods.

Meyer warns that signing an AOD carries serious consequences.

“For those who sign, it means they’re admitting guilt, which could amount to fraud under the Health Professions Act and potentially lead to losing their licence,” she said.

Beyond the financial strain, the emotional toll on practitioners appears severe. The study found that many participants experienced symptoms consistent with trauma, including anxiety and physical stress reactions.

One physiotherapist described the experience starkly: “Seven months of watching my father die was easier than this.”

The research suggests that these experiences are not isolated incidents but part of a broader systemic problem within the auditing process.

A key issue identified is the lack of coordination and oversight between regulatory bodies. While practitioner conduct falls under the HPCSA, medical schemes are governed by the Council for Medical Schemes (CMS). However, participants reported that complaints to the council often went unanswered, leaving them without recourse.

The study also points to structural challenges within the healthcare system, including outdated billing codes. Tariffs last updated in 2006 do not reflect modern treatment methods, forcing physiotherapists to either adapt outdated codes or leave certain services unbilled. This creates discrepancies that can trigger audits and accusations of overbilling.

Meyer argues that these conditions contribute to a hostile environment where practitioners feel presumed guilty and pressured into compliance.

“The process contradicts the principle of procedural fairness, which requires transparency, impartiality and the opportunity to be heard,” she said.

To address these concerns, the study recommends several reforms. These include introducing forensic literacy training for physiotherapists, establishing independent oversight mechanisms, and standardising audit procedures.

Meyer has already begun implementing some of these changes, developing a series of lectures for fourth-year physiotherapy students at the University of Pretoria to better prepare them for potential audits.

The study also calls for a system that allows practitioners to access evidence, respond to allegations and appeal decisions — measures aimed at restoring trust and ensuring accountability on both sides.

Since the study was completed, an independent legal panel reviewing the application of Section 59(3) of the Medical Schemes Act has released its final report, confirming many of the concerns raised by Meyer, including lack of transparency and potential misuse of power.

Meyer says while the report is a step forward, meaningful reform will depend on how its recommendations are implemented.

“If we don’t address the lack of oversight, we risk losing good practitioners and damaging trust in the healthcare system itself,” she said.

The findings raise urgent questions about the balance between protecting medical scheme funds and safeguarding the rights and wellbeing of healthcare professionals – a balance the study suggests is currently out of step.