A managed health care organisation’s accreditation renewal - What happens when the decision comes too late?

Authored by Michelle David and Ntokozo Ngubane.

Accreditation renewal in the managed health care space can become contentious, particularly where a regulator raises concerns about the accredited entity but does not provide the material underpinning those concerns.  The high court decision in 3Sixty Health (Pty) Ltd v Council for Medical Schemes (Case 2026-090602) confirmed that where a regulator fails to decide on a renewal application before the accreditation expires and does not disclose the information on which it relies, a court may grant interim relief preserving the accreditation. 

The facts of the case were as follows.

1. 3Sixty Health (Pty) Ltd (3Sixty Health) is a managed health care organisation (MHCO) that had provided managed care services for decades to a number of medical schemes. It could only do so if it holds accreditation from the Council for Medical Schemes (CMS) under Regulation 15B of the Regulations to the Medical Schemes Act, 1998 (MSA) (the “Regulations”).
2. 3Sixty Health's accreditation was due to expire on 25 April 2026.  It submitted its renewal application to the CMS on 16 January 2026, well within the three-month period before expiry required by Regulation 15B(7).
3. During 2024 and 2025, concerns had arisen about 3Sixty Health's affairs, including a KPMG investigation concluded in 2025 and reports produced in the context of curatorship proceedings overseen by Ms Mpakati (former curator) and Mr Fleming (current curator).
4. On 19 March 2026, CMS wrote to 3Sixty Health raising concerns about whether it remained fit and proper, had the necessary systems, resources, skills and capacity, and met the requirements for renewal.  The letter warned that 3Sixty Health did not meet two of the three regulatory criteria.
5. 3Sixty Health responded that the letter was framed too generally, that some allegations appeared to reflect conclusions already reached, and that no supporting material had been provided. It requested the full KPMG report (of which it had received only an executive summary), curator reports from Ms Mpakati and Mr Fleming, records of meetings, complaints and the other material underlying CMS's concerns.
6. By 13 April 2026, no documentation had been provided. 3Sixty Health requested that CMS maintain its accreditation pending receipt of the material and a proper process for engaging with the concerns.
7. CMS did not agree. It indicated that its board would only decide on 29 April 2026, whether to approve 3Sixty Health’s renewal application four days after the accreditation was due to expire.   The timing meant that 3Sixty Health's accreditation lapsed by effluxion of time on 25 April 2026, before the board had decided the renewal application, leaving 3Sixty Health without   accreditation despite having applied for renewal in time. 

Against that background, 3Sixty Health found itself in exactly the position that Regulation 15B is designed to prevent that of an MHCO whose accreditation expired before CMS had decided its renewal application, despite having submitted in time.

3Sixty Health launched an urgent application (Part A) in the high court seeking, in essence, an order preserving its accreditation pending review or appeal under the MSA, together with an order compelling CMS to provide the underlying documents and afford it a reasonable opportunity to respond.  The nub of 3Sixty Health's case was that CMS had failed to make a timely decision on its MHCO accreditation as required by the Regulations and that the process was procedurally unfair because 3Sixty Health had not received the information it needed to respond, in breach of Regulation 15B(3).

CMS's position was that the application was premature because no final decision had been made.  CMS further submitted that 3Sixty Health had not exhausted internal remedies as required by section 50(3) of the MSA read with section 7(2) of Promotion of Administrative Justice Act, 2000 (PAJA) and that the request for documents was impermissible pre-litigation discovery that should have been pursued under the Promotion of Access to Information Act, 2000 (PAIA).

The court was not persuaded by the above and its reasoning can be distilled into the following points.

8. On procedural fairness, the court held that Regulation 15B(3) is unambiguous in that, where CMS relies on information "derived from whatever source", it must disclose that information to the applicant and afford the applicant a reasonable opportunity to respond. The Regulations themselves imposed this obligation on CMS, making a resort to PAIA unnecessary.
9. On the regulatory framework, the court found that Regulation 15B envisions a structured process in which a timely application triggers CMS's obligation to decide before the accreditation expires.  The three-month lead time in Regulation 15B(7) exists to prevent exactly the situation that arose in this matter.
10. On internal remedies, the court held that because no final decision had been made, there was no decision to appeal.  Section 7(2) of PAJA did not prevent the court from granting interim, preservative relief.  Once CMS makes a lawful decision after a fair process, 3Sixty Health will remain obliged to pursue the internal remedy.

It is important to note that in this matter, the court did not "renew" the accreditation, as that would have been stepping into the shoes of CMS's statutory function.  Instead, it granted restorative and preservative relief, authorising 3Sixty Health to continue all activities under its accreditation as it stood immediately before 25 April 2026, pending the final determination of review or appeal proceedings.  In addition, CMS was ordered to provide, within 30 days, the documents necessary for 3Sixty Health to respond to the 19 March 2026 letter, after which 3Sixty Health would have up to three months to respond.

The key takeaways from the above are that where a regulated entity applies for renewal in time, the regulator must decide before the accreditation expires. If it does not and fails to provide the information needed for a fair process, a regulated entity may approach the court relief preserving the status quo.  In addition, the practical lesson is that under section 33 of the Constitution, PAJA, and the Regulations, a decision-maker relying on adverse information must disclose the underlying material and afford the affected party a reasonable opportunity to respond before any consequences take effect.

Efficiency and operational requirements rely on entities being accredited, it is important not just for such entities to make applications for accreditation timeously but also for the regulator to ensure that it follows a process as contemplated in statute and which promotes service delivery to members, aligning with the objects of the regulator. 

3Sixty Health (Pty) Ltd v Council for Medical Schemes (Case 2026-090602) [2026] ZAGPJHC (30 April 2026)