Fraud allegations threaten universal health scheme

• ‘HMOs operate with expired licences’
• Operators allege disruption to NHIS scheme
• Nigeria records 33.7 deaths per 100,000 yearly

The plan by the Federal Government to achieve universal health coverage (UHC) through the National Health Insurance Scheme (NHIS) has suffered yet another setback.

The scheme and its operators, including the Health and Managed Care Association of Nigeria (HMCAN) and Health Care Providers Association of Nigeria (HCPAN), are trading accusations over alleged financial misappropriation.

HMCAN is the umbrella body of health maintenance organisations (HMOs), licensed operators of the NHIS. The bodies provide or arrange managed care for health insurance, self-funded health care benefit plans, individuals and other entities as well as act as a liaison for health care providers (hospitals, doctors, etc.) on a prepaid basis.

HCPAN was an offshoot of Decree 35 of 1999 that establishes NHIS to provide approved health services at retainer hospitals to the enrollees.HMCAN and HCPAN have, however, raised the alarm over alleged disruption and distortion of the scheme.

The Chief Executive Officer (CEO)/Managing Director of Ultimate Health Management Service, one of the HMOs, Mr. Lekan Ewenla and the National President, HCPAN, Dr. Umar Oluwole Sanda, told The Guardian that since his assumption of duties, the Executive Secretary of the NHIS, Prof. Yusuf Usman, had changed the payment pattern from prepaid to postpaid, whereby payments that were to be effected at the beginning of each quarter are now done on a monthly basis.

Ewenla said the implication of this alleged distortion was that the healthcare providers would not have the fund to provide services as earlier designed, resulting in the enrollees being denied access by facilities.

Sanda noted that the development had resulted in the re-introduction of out-of-pocket payment, which the scheme was designed to completely eliminate. This situation, according to him, has led to the enrollees and healthcare providers beckoning at their HMOs for help, far beyond their control.

But the NHIS boss, in his reaction, accused the HMOs of defrauding and owing the scheme and the primary care providers to the tune of N90 billion, even as he threatened to delist and publish the names of defaulting companies.

Usman told The Guardian that the licences of all the HMOs had expired. According to him, none has a legal licence to practise. He said: “We give them money upfront to pay the retainer hospitals nationwide but they do not. They keep the money. For the first time, the NHIS is working for the people not the HMOs.

They owe all the retainer hospitals nationwide. HMOs have been feeding fat on people’s money. They have to pay back all the money. I am going to publish the names of all the corrupt HMOs soon in the newspapers.”

Usman had last August accused them of criminal negligence. According to him, despite the fact that the NHIS releases funds three months ahead for the payment of the retainer hospitals where the enrollees are attended to, most of the HMOs do not pay the capitation to the hospitals.

The situation is critical since 90 per cent of Nigerian hospitals depend on the capitation to survive, he said. Meanwhile, the Federal Road Safety Corps (FRSC) has said Nigeria records 33.7 deaths per 100,000 persons yearly, making her one of the nations with the highest fatality rate on the African continent.

Quoting the World Heath Organisation (WHO) statistics, the Corps Marshal, Boboye Oyeyemi, during the kick-off of the Global Road Safety Week at the Nigeria Union of Journalists (NUJ) secretariat in Kaduna yesterday, said with a population of 178.5 million and over 7.6 million cars plying her 204,000-kilometre road network, the nation ’s road infrastructure face a high pressure resulting high rate of accidents.

A statement quoted Oyeyemi as saying: “FRSC, in its mitigating efforts, has introduced the installation of speed limiter devices in commercial vehicles and has been monitoring compliance.” Represented by the Deputy Corps Commander, Kaduna Zone, Yomi Asaniyan, he put the level of compliance at 33 per cent.