… As 32 doctors, pharmacies and practices go under the microscope
By Patience Nyangove
GOVERNMENT has so far paid N$710 million in the past four months, to health service providers who were owed money by the Public Service Employee Medical Aid Scheme (PSEMAS), Confidente has learnt.
At the same time, the Finance Ministry has also flagged at least 32 medical doctors, pharmacists, physiotherapists and laboratories, for allegedly submitting fictitious claims to PSEMAS.
Finance Minister Calle Schlettwein on Tuesday confirmed the payment of the money, saying the ministry was only left with claims emanating from the past 52 days, which it is yet to settle.
“We have caught up with our payments, and we have managed to pay N$710 million so far in outstanding invoices, and everything is going well,” Schlettwein said.
He also disclosed that a forensic investigation, carried out by his ministry, has established how around 32 medical practitioners had allegedly tried to defraud the medical aid, by submitting false claims.
Confidente understands some of the alleged culprits had submitted claims amounting to several millions of dollars over the years, and had nearly got away with their scam to use government as a cash cow.
The Ministry of Finance intends to blacklist all medical practitioners, who have tried to scam government.
“This number (the 32) includes pharmacists, medical doctors, physiotherapists and laboratories, who submitted claims that were found to be unsubstantiated. These people are now subject to further investigations, as we are not done yet,” Schlettwein said.
The Ministry of Finance launched an investigation into claims submitted to PSEMAS earlier this year, after medical service providers claimed around N$125 million in less than two weeks in December last year.
Confidente is informed that one medical doctor claimed as much as N$1.2 million from PSEMAS in December, which led to the Ministry of Finance holding its purse tightly closed, until it completed its investigations into the authenticity of the claims.
Government had also informed health service providers that they will not be paid through PSEMAS, but that they are expected to render health services, until the Ministry of Finance concludes its investigations into possible fraudulent claims.
In April, Finance Permanent Secretary, Ericah Shafudah, in a bid to cut out the rot that has engulfed the PSEMAS, issued notices to service providers that the ministry intends to terminate its previous agreements with them, by 31 May.
Confidente understands that although this deadline has lapsed, new contracts are yet to be signed between the ministry and the health service providers.
The original notices had said that the ministry was giving health service providers 60 days’ notice, from 1 April, in order to phase out the old PSESMAS agreements.
The notices stated that if health service providers fail or refuse to sign the new agreements by 1 June, PSEMAS members will have to pay them directly, before claiming their money back from the medical aid scheme.
Shafudah had also told healthcare professionals that the new service provider agreements were necessary, in order to align PSEMAS to the changes that have taken place in the sector over the years.
She also highlighted that the ministry was busy reviewing the current benefit structure, rules and agreements, which governed the direct submission and payment of healthcare professional claims, through the PSEMAS administrator.
“In terms of Section 12.4 of the (existing) agreement, the Ministry of Finance and PSEMAS, wishes to inform all healthcare providers that this agreement will be terminated, and wishes to give 60 days’ notice, as from 1 April till 31 May 2017.
“Due to the involvement of all stakeholders, the amended agreement will only be effective from 1 June 2017, and no new agreements will be allocated until the respective date of 1 June 2017, as indicated. The new agreement will be available for signature as from 1 May 2017. Please take note that if any healthcare professional doesn’t have a signed agreement, the PSEMAS member must first pay, and then claim,” Shafudah wrote.
Confidente. Lifting the Lid. Copyright © 2015