MediCheck Secures Reversal Of Discovery Health Clawback Affecting 16 500 Members 

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Johannesburg – MediCheck, representing over 1 500 affected members, says it welcomes Discovery Health’s announcement that it will absorb the full cost of a claims processing error.

Discovery initially announced plans to recover overpayments on certain Above Threshold Benefit claims from 2025, due to a year-long system error in processing pharmacy and medication claims.

However, after a backlash, the medical aid reversed its stance rather than pursue recoveries from 16 500 Discovery Health Medical Scheme members.

The decision, announced by Discovery on Sunday, 11 January 2026, 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.

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, 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.”

Key timeline:

• Early January 2026: Discovery notifies 16,507 members of recovery demands
• 5 January: MediCheck issues formal dispute notice and demands for substantiation
• 6 January: Discovery requests a meeting with MediCheck
• 7 January: MediCheck issues urgent cease-and-desist notice as deductions begin
• 9 January: Emergency meeting between Mark Hyman and MediCheck counsel Advocate Lewis Rosen and Discovery executives
• 11 January (11h30): Discovery announces full reversal

The reversal means that:

• All 16,500 affected members are released from any repayment obligation
• Deductions already made from Medical Savings Accounts, Personal Health Fund, or HealthPay accounts will be reinstated
• Members who have already repaid amounts will receive full refunds
• No impact on any member’s 2026 benefits

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,” Hyman said.

“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.”  

MediCheck said it 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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