A year-long administrative failure at Discovery Health Medical Scheme (DHMS) has sparked mounting frustration among members, as the scheme begins recovering erroneous payments from policyholders. The Discovery Health claims error, which went undetected for 12 months, has affected an estimated 16,000 members across five high-end plans.
The administrator, Discovery Health, is now requesting repayment of substantial amounts, some exceeding R68,000. Many members, particularly retirees and low-income families, are calling the move both “tone-deaf” and financially devastating.
The root of the issue lies in a systemic internal claims processing error in 2025. Although Discovery has acknowledged the error and is legally entitled to recover funds under Section 59 of the Medical Schemes Act, the way it has handled communication and accountability has drawn heavy criticism.
Who Pays For Mistakes?
Discovery Health earned R6.3 billion in administration fees from DHMS in 2024, with about R705 million allocated specifically to claims processing. On the five affected plan types - Executive, Classic Comprehensive, Classic Smart Comprehensive, Classic Priority, and Essential Priority - members paid an average of R482 per month for claims management in 2025.
Over the year, the error persisted, which amounts to roughly R5,800 per member. Critics argue that this cost should not fall solely on members, especially when it stems from a failure in the administrator’s core responsibility.
Despite the significant sums involved, there is no mechanism for DHMS to hold Discovery Health financially accountable for the failure. Contracts between schemes and administrators often insulate the latter from liability — a situation now facing renewed scrutiny from both members and regulators.
Discovery Health Claims Error Raises Regulatory and Ethical Questions
Discovery's apology has been widely panned. Buried in the second-last paragraph of a long recovery letter, the tone and timing of the message have left members feeling overlooked. Many question how such a large administrator could overlook a systemic error for almost a year - especially when quarterly audits should have flagged the discrepancy.
The Council for Medical Schemes (CMS) has confirmed that recoveries are legally permissible. However, it stressed that such processes must meet high standards of transparency, fairness, and courtesy. The CMS has also signalled concern about how Discovery is managing the recovery process, especially given the timing. Letters sent to affected members were based on data processed as late as 18 December 2025, suggesting a hurried effort during the festive season.
Calls Grow For Accountability In Medical Scheme Administration
There is currently no penalty mechanism to hold Discovery Health accountable for the error or to force it to absorb part of the cost. This has prompted calls to review existing contracts between schemes and their administrators. Critics argue these arrangements favour administrators and leave members exposed when errors occur.
Many members are demanding that the administrator reverse or offset the amounts due, particularly for vulnerable individuals. Some suggest that administration fees should be clawed back from Discovery rather than from policyholders who acted in good faith.
With the CMS now monitoring the situation, pressure is mounting for structural reform in how medical schemes oversee their third-party administrators. For affected members, the Discovery Health claims error has done more than cause financial strain — it has also eroded trust in South Africa’s largest medical scheme.