The Health and Managed Care Association of Nigeria (HMCAN), an umbrella body of the Health Management Organisations (HMOs) in the country and the Healthcare Providers Association of Nigeria (HPAN) say they will strengthen their joint disciplinary committee to sanction operators who flout standards.
Lekan Ewenla, National Publicity Secretary of the Health and Managed Care Association of Nigeria (HMCAN) in press briefing on Wednesday in Lagos, said the committee, Joint Ethics or Standard Compliance Committee will enforce compliance with the operational guidelines that was developed by the National Health Insurance Scheme (NHIS).
“The aim of the committee is to monitor the compliance standards, the compliance parameter by all the HMO and Healthcare providers. So based on the operational guideline, all conditions, all parameters, all standards that were set in that operational guidelines must be seen complied forthwith; any HMO that does not comply with it should be reported to the committee. Then the committee will sanction,” said Ewenla.
HMOs in Nigeria have been embroiled in conflict with the NHIS over a purported debt to healthcare providers. Last month, Usman Yusuf, NHIS boss accused the HMOs of owing over N351 billion for services rendered by healthcare providers across the country.
The claim was refuted by HMCAN who maintained that over 70 percent of the amount has been remitted to healthcare providers across the country and even called for an independent investigation into the claims. This led to the suspension of the NHIS boss.
In a bid to establish standardised operational guidelines, Ewenla said the committee had been established and enjoined HMOs in the country to be accredited by the NHIS and work strictly with the operational guidelines developed by the NHIS.
“That means any provider that is providing services on the health insurance scheme or platform must be accredited by the NHIS and be a member of the association.
So also so with the way things are in Nigeria whoever is accredited by NHIS as HMOs either you belong to this particular association or not you must comply with the set standards, you must comply with whatever standard
To resolve the contending issue of bill settlement, Ewenla urged HMCAN members to settle bills within 30 days. “All HMOs must comply with the directive and settle bills, this committee suggested that maximum of two weeks moratorium should be added to those four weeks making six weeks.”
“Failure for the HMOs to settle that bills the healthcare providers should stop seeing their enrollees from that particular HMO and now do their report to this committee so that the committee can sanction.”
Ewenla further said that the joint committee wants Nigerians to begin to have value for their contribution on the health insurance platform.
“The era and the issue of enrollees on this scheme being treated like lepers we want to eliminate it, we want to get it right. So whatever might be the cause of the enrollees not been given the desired quality of care we want to identify it and convert it to opportunity”.
