MediCheck welcomes reversal of Discovery Health clawback

 MediCheck, representing over 1 500 affected members, has welcomed Discovery Health's announcement that it will absorb the full cost of a claims processing error rather than pursue recoveries from 16 500 Discovery Health Medical Scheme members.

The decision, announced by Discovery Sunday night, follows a week of intensive engagement by MediCheck on behalf of affected members who faced recovery demands – in some cases exceeding R80 000 – for an administration error they did not cause.

Discovery Health announced that it will cover the cost of a claims system error that resulted in the overpayment of certain Above Threshold Benefit (ATB) claims during 2025.

Affected Discovery Health Medical Scheme members will not be required to repay any amounts related to the error, and no other members of the Scheme will be disadvantaged because of this decision.    The error affected a limited group of members whose ATB claims were inadvertently overpaid during 2025. With Discovery Health absorbing the full cost, neither the Scheme nor any members are negatively impacted in any way. 

Dr Ron Whelan, the CEO of Discovery Health, said: "Notwithstanding the validity of the recovery, having carefully listened to members’ concerns and considered their individual experiences and circumstances, Discovery Health has decided to cover the cost on members’ behalf." 

The error affected 16 507 members across certain Executive, Comprehensive and Priority plans where ATB applies. The affected group represents 10.5% of the members on those plans, and less than 0.6% of the Scheme’s total membership. There is no impact on members outside this group, and benefits for 2026 across all plans remain completely unaffected.   

Discovery Health said for affected members, claims statements will be updated to reflect this decision. Any deductions made to Medical Savings Accounts, Personal Health Fund or HealthPay accounts will be reinstated, and members who have already repaid amounts will be refunded in full. A dedicated service team will contact affected members directly to address outstanding queries and provide clarity.    

Dr Whelan, the CEO of Discovery Health, said “We apologise unreservedly to members affected by this error. Covering this cost is the right decision, one that reflects our commitment to fairness, integrity and putting members first, especially when we fall short.”  

 MediCheck is an independent medical scheme advocacy firm that assists members in disputes with medical schemes and holds schemes accountable to regulatory standards.

 "We welcome Discovery Health's decision to do the right thing and absorb the cost of their own error," said Mark Hyman, the  CEO of MediCheck. "Our members were facing significant financial pressure over an issue that was entirely outside their control, which is why we lodged the issue with the Council for Medical Schemes. This outcome ensures no member is financially prejudiced by Discovery's systems failure." 

MediCheck estimates the total value of disputed recoveries to be between R130 million and R170 million, based on the number of affected members and the range of individual recovery amounts reported.

 While welcoming the outcome for members, Hyman says the case raises important questions about medical scheme governance and administration controls.

 "Under the Medical Schemes Act, the Board of Trustees is responsible for ensuring proper control systems. When a systemic error of this magnitude occurs across an entire benefit year, members deserve answers about what went wrong and what safeguards are now in place," Hyman said.

 MediCheck will continue to monitor the situation to ensure all reversals and refunds are implemented correctly and is calling on the Council for Medical Schemes to review the governance and administrative failures that enabled the error.

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