Health and Management Care Association of Nigeria (HMCAN), umbrella body of Health Management Organisations (HMOs) in Nigeria, has countered the claims from the House Representatives that HMOs received N351 billion as payments from the National Health Insurance Scheme (NHIS).
The body calls on NHIS to restrict itself to regulatory functions and allow the HMOs drive the scheme, adding that the overzealous activities of NHIS is affecting the nation’s health insurance sector negatively.
Recall that last Thursday, the House of Representatives mandated its committee on healthcare services to probe the quality of services rendered by HMOs, despite receiving the large sum of N351 billion from NHIS.
The House also ordered NHIS to suspend further release of quarterly fund to HMOs, pending the outcome of the investigation expected to last four weeks.
Addressing journalists on Tuesday, in Abuja, HMCAN executives led by Kolawale Owoka, Lekan Ewenla and Tunde Ladele, president, publicity secretary and treasurer, respectively, refuted the claim by the House that they received the sum.
They stated categorically that the report is a false information been bandied around by the NHIS, the government institution which according to them has since abandoned its primary responsibility of being the regulator of the scheme to also become an operator.
Owoka said the money been mentioned by the House was the total premium paid by enrolees in the last 11 years, which is domiciled with the NHIS, of which 10 percent is usually remitted to HMOs on quarterly basis.
“HMOs are still mandated to provide security for that money,” the HMCAN president stated, adding that the premiums paid by enrolees were meant to be paid to hospitals, to dispense services to enrolees, which has also been paid to them.
Giving more clarification about how funds in the scheme run, Ewenla, the publicity secretary, said, “the quarterly funds from NHIS differ among HMOs, as it depends on the number of enrolees each HMO has.”
While exonerating HMOs of alleged embezzlement, Ewenla stated, “On a quarterly basis, NHIS send their staff to individual HMOs to go for reconciliation. Before the staff is even sent, it is mandatory that individual HMOs must send their statement of accounts to NHIS. That is the standard process.
“Whatever money that is not paid to any hospital either based on the fact that the hospital is no longer in existence or has changed location, must be returned to NHIS and they are always returned.
“There is no money with any HMO as we speak today. If there is, let NHIS name the HMO,” he said.
While further accusing NHIS as the main cause of the falsehood been spread that HMOs were paid N351bn, the HMCAN Publicity Secretary accused NHIS of over meddling in the operations of HMOs, a development which according to him is stalling the progress of the scheme in the country.
“By the law establishing the scheme, the NHIS is meant to be the regulator of the scheme, just like Central Bank of Nigeria (CBN) and National Pension Commission (PenCom) regulate the banking and Pension industry respectively.
“The scheme is supposed to be driven on the platform of Public-Private partnership, whereby the government regulates and the private sector drives the scheme through its operations. But the most unfortunate thing from the inception of the scheme, NHIS has been seeing themselves both as operator and regulator.
“We have had cases where we go for presentation and we meet NHIS team making the same presentation for the same scheme we are running. That has been the issue.
“The activities of NHIS are affecting the growth of the scheme. While HMOs are looking at how to grow the scheme, the regulator is looking at how to grow money. They are two different objectives,” he lamented.
While appealing to the National Assembly to grant them fair hearing, in the course of its investigation, HMCAN expressed their readiness to lay all facts and figures bare for proper understanding of what is truly transpiring in the sector.
“We are going to make a presentation to the National Assembly. We want to implore them to invite all of us the stakeholders, starting from NHIS to the HMOs and everybody must come with facts and figures. Enough of this blackmailing. Enough of this name tagging,” Ewenla stated.
While urging NHIS to step up the performance of its constitutional mandate for the betterment of the scheme, HMCAN urged them “to put in a very robust ICT platform to interface with the HMOs then there there will be nothing hidden. When last did you hear PenCom insulting Pension Fund Administrators (PFAs), they queried.
The vision of HMOs according to them is to grow the health insurance scheme and that they have the capacity and infrastructure to achieve the goals.
AMADI NNAMDI, Abuja
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