The Health and Managed Care Association of Nigeria (HMCAN) has called on the executive secretary of National Health Insurance Scheme (NHIS), Usman Yusuf to name those health maintenance organisations (HMOs) that are breaching standards, or engaged in sharp practices.
HMCAN is the umbrella interest-organisation for all HMOs in Nigeria.
According to the Chairman, Tunde Ladele speaking in Lagos yesterday, it is not possible that all HMOs are operating with total defaults, “as being advanced to the public by the NHIS’s Executive Secretary. As regulators, we believe NHIS has the statutory authority, the operational mandate, and instruments to enforce compliance in the industry”.
Ladele said it is good to put the records straight on the refund of backlog of N2.1b, to NHIS, saying, “On his assumption of duty at the Scheme in 2016, Prof Yusuf without once consulting with the HMOs, till this moment, insisted vehemently that the 50 percent of this payment of this backlog to HMOs must be refunded, threatening to shut down the industry otherwise.
“As critical investors with huge investments in the Nigerian healthcare space, the HMOs unanimously agreed to make the refund to avoid dislocations in the industry,” said Ladele, adding, “it was therefore a business decision by the HMOs to make the refund, and not necessarily because the payment was not properly earned, an impression Prof Yusuf has laboured to sell to the public”.
Ladele added that the refunds HMOs are making to the NHIS is a sacrifice by them to save the industry and the circumstances surrounding this need a clear understanding.
Giving the background, Ladele said: “It was an actuarial recommendation that payments of capitation, fee-for-service and admin fee be reviewed on the average of every two years, in view of inflationary trends in the economy. However, no such review had taken place between 2005 and 2012”.
He added, “In response to pressure from critical stakeholders, such as healthcare facilities who are risk bearers at the primary level, the review finally occurred in 2012. Consequently, capitation was increased from N550.00 to N750.00, fee-for-service from N89.00 to N112.50, while administrative fee went up from N91.00 to N129.00”.
Ladele said NHIS implemented this review, except for fee-for-service outstanding from 2012 to 2015, amounting to N2.1b, adding, “HMOs, being risk bearers at secondary and tertiary levels are expected to pay for services authorised at these two levels for fee-for-service as denominated and defined by NHIS. After a very long wait, 50 percent of the backlog of N2.1b was paid by NHIS to the HMOs in 2016, leaving a balance of 50 percent to date, and on his resumption at the scheme in 2016, Prof Yusuf insisted that the 50 percent of this backlog to HMOs must be refunded, and we did,”.
As of today, according to Ladele, all the 59 HMOs were deactivated without concrete cause, as “majorities were compliant with set criteria. We see this move as a betrayal of leadership inadequacies, poverty of administration and management skills, weak knowledge of technical issues, gross deficiencies in understanding of corporate governance and a sorry state of inability to relate well with higher authorities by Prof Yusuf,”.
Ladele said the current bitterness and acrimony in the young industry is unnecessary and avoidable, saying, “Prof Yusuf should make himself available to answer to charges of procurement law breaches, abuse of office, and financial brigandage that are pilling against him, rather than stifle himself with this phobia for HMOs’.