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Medical Schemes Act, 1998 (Act No. 131 of 1998)

Regulations

Regulations in terms of the Medical Schemes Act

Chapter 5 : Provision of managed health care

15C. Suspension or withdrawal of accreditation

 

1) The Council may, subject to subregulation (2), at any time suspend or withdraw any accreditation granted in terms of regulation 15B if the Council is satisfied on the basis of available information, that the relevant managed health care organisation –
a) no longer meets the criteria contemplated in regulation 15B(2)(d);
b) did not, when applying for accreditation, make a full disclosure of all relevant information to the Council, or furnished false or misleading information;
c) has, since the granting of such accreditation, contravened or failed to comply with any provision of this Act;
d) has, since the granting of such accreditation, conducted his or her business in a manner that is seriously prejudicial to clients or the public interest;
e) is financially unsound; or
f) is disqualified from providing managed health care services in terms of any law.

 

2)
a) Before suspending or withdrawing any accreditation, the Council must inform the managed health care organisation concerned of –
i) the intention to suspend or withdraw the accreditation and the grounds therefor;
ii) in the case of suspension, the intended period therefor; and
iii) any terms attached to the suspension or withdrawal, including such measures as the Council may determine for the protection of the interests of the clients of the managed health care organisation, and must give the managed health care organisation a reasonable opportunity to make a submission in response thereto.
b) The Council must consider any such response, and may thereafter decide to withdraw or suspend or not to withdraw or suspend the accreditation, and must notify the managed health care organisation of the decision.
c) Where the accreditation is suspended or withdrawn, the Council must make known the terms of the suspension or withdrawal or subsequent lifting thereof, by means of any appropriate public media announcement.

 

3) During the period that the accreditation of a managed health care organisation has been suspended, such person may not apply for renewal of the accreditation or reapply for accreditation.

 

4) On withdrawal of the accreditation of a person as a managed health care organisation, the Council may determine a reasonable period within which such person may not reapply for accreditation as a managed health care organisation, taking into account the nature of the circumstances giving rise to such withdrawal.