JHB 
INSIGHTS
Mistakes Medical Practices and Practitioners Make
If you have recently qualified as a medical specialist and you are planning to start your own practice, congratulations. You are stepping into one of the most rewarding seasons of your professional life.
But here is what I see repeatedly – brilliant medical specialists making avoidable business and compliance mistakes, not because they are negligent, but because they were never trained in practice governance.
The Health Professions Council of South Africa (HPCSA) provides clear guidance in its Business Practice Policy, Ethical Rules, and Good Practice Guidelines. Yet many new medical practices only discover these rules and guidelines when something goes wrong.
Below we unpack the most common mistakes and the correct best practice approach.
Choosing the Wrong Legal Structure
The Mistake
Starting a practice using a structure that is not permitted by the HPCSA, for example:
- A standard (Pty) Ltd company
- A trust
- A structure involving non-medical practitioners as shareholders
- A “creative” hybrid model not recognised by HPCSA
The Guideline
The HPCSA recognises the following acceptable business models only:
- Solo practice
- Personal Liability Company (Incorporated Practice – “Inc.”)
- Partnership / Group practice
- Association
- Franchise (subject to ethical compliance)
No other structure is permitted unless specifically approved by HPCSA.
If you are incorporating, the correct structure is a Personal Liability Company (Inc.), not a standard Pty Ltd.
If in doubt you should approach HPCSA for guidance before registering.
The Mistake
Allowing:
- A spouse
- An investor
- A management company
- A hospital group
to hold shares directly or indirectly in your professional practice.
The Guideline
Direct or indirect corporate ownership by anyone who is not registered under the Health Professions Act is not permitted. The practice must be owned by registered medical practitioners only.
If structured as a company:
- All shareholders must be registered medical practitioners.
- All directors must be registered medical practitioners.
Incorrect Naming of the Practice
The Mistake
Using names such as:
- “Advanced Surgical Institute”
- “Elite Medical Clinic”
- Any name implying institutional affiliation
The Guideline
The practice name must reflect:
- Your own name, OR
- The name of registered medical practitioners in partnership, OR
- The names of practitioners forming the juristic entity
You may not use terms like:
- “Hospital”
- “Clinic”
- “Institute”
- Or anything suggesting association with such institutions if not factual.
Improper Group Practice Structures
The Mistake
Forming multidisciplinary group entities that fall outside permitted professional combinations.
The Guideline
Rule 8 of the Ethical Rules states that a practitioner shall practise in partnership, association, or juristic person only within the scope of the profession in respect of which he or she is registered.
Limited exceptions apply, such as:
- Pathologist with Medical Technologist
- Radiologist with Nuclear Physician or Radiographer
Outside those exceptions, group structures must remain within the same professional scope.
Before forming a group practice, you should confirm compliance.
Charging Interest Incorrectly
The Mistake
Charging interest freely on overdue accounts as if operating under the National Credit Act.
The Guideline
A practitioner:
- May enter into written payment arrangements with patients.
- May not treat this as a credit agreement.
- May not charge general interest like a lending institution.
However, if:
- A medical scheme rejects payment AND
- The patient fails to settle
You may revoke the discounted price offer and charge up to 2% per month from due date.
Written consent and proper documentation are required.
Incorrect Billing Codes
The Mistake
Using:
- Incorrect procedure codes
- Inflated codes
- Generic or unrelated codes
- Guesswork coding
Often this happens because billing systems are outsourced without oversight.
The Guideline
You are responsible for correct billing even if you outsource.
If no specific code exists:
- Use a code that reasonably includes the procedure rendered.
Incorrect coding exposes you to:
- Audit risk
- Clawbacks
- Professional misconduct allegations
Split Billing
The Mistake
Billing:
- The medical scheme separately for tariff amount
- The patient separately for shortfall, without reflecting the full-service cost on both
This is known as split billing and it is unethical.
The Guideline
Split billing is not.
The full account must reflect the full service rendered.
Charging in Advance Incorrectly
The Mistake
Charging full consultation or procedure fees before services are rendered.
The Guideline
Advance fees are only permitted for:
- Costs of prostheses
- Medical aid co-payments required from the patient
- Foreign patients requiring health services in South Africa
- Custom-made devices that are not reusable
In all other instances, fees must be charged after services are rendered.
Advertising
The Mistake
Advertising in a mall or public space and offering:
- “Free quotes”
- “We are cheaper than others”
- “Best specialist in Gauteng”
This constitutes canvassing.
The Guideline
Advertising is permitted only if it is:
- Truthful
- Professional
- Not misleading
- Not causing unwarranted anxiety
Shareholding Between Practices
The Mistake
Allowing one incorporated practice to control or own another beyond permitted thresholds.
The Guideline
A Personal Liability Company may hold shares in another practice only if:
- All shareholders and directors are registered medical practitioners
- It does not own or control more than 24% of issued share capital
Anything above 24% breaches the permitted threshold.
Final Thoughts for the Young Medical Specialist
Starting your own practice is exciting but here is the reality that many practitioners focus intensely on:
Equipment
Rooms
Branding
Location
Very few focus on:
Structure
Ownership
Ethical compliance
Billing governance
Revenue integrity
If you are about to start your practice, pause before:
Registering companies
Signing leases
Onboarding billing providers
Ensure your structure and governance are correct from day one, because fixing compliance mistakes later is always more expensive than setting it up properly.
If you get the foundation right, you build something sustainable. And sustainable practices build freedom.
Paul Botha B Compt (Hons), Professional Accountant (SA)
15 April 2026