By Kauthar Anumba-Khaleel
…HMOs are fraudulent – NHIS Boss
…23 million ghost enrollees discovered
The minister of Health, Prof. Isaac Adewale has lamented that the N351bn premium paid out for the National Health Insurance Scheme is not commiserate to healthcare services given Nigerians.
This is as the executive secretary of National Health Insurance Scheme (NHIS), Prof. Usman Yusuf has alleged that Health Maintenance Organizations, HMOs is a conduit pipe for corruption in the health sector.
The minister said this yesterday at a two day public hearing on the need to investigate the compliance rate of Health Maintenance Organization to the NHIS contributions and utilization of funds by the healthcare providers and inhuman treatment of enrollees organized by the House of Representatives committee on Health services.
Prof Adewale who was represented by the Director of Hospital Services, Dr. Balami observed that there are key issues of concern with the operations of the scheme as the over N351bn which has been paid out as premium has yielded little or no result and urged the House to consider the role of HMOs in the scheme.
“There are indeed key issues as raised by the House. These have to do with the practices of HMOs and most importantly, the way enrollees are treated. I am glad that this matter is before the committee and all stakeholders are gathered here to air their views. At the end of the hearing, we will decide whether HMOs are necessary despite the N351bn given to them
Similarly, the executive secretary of NHIS, Prof. Usman Yusuf noted that there was fraud in the delivery of healthcare services in Nigeria as HMOs manipulated the figures of enrollees to benefit them regardless of the fees paid to it by the government.
Yusuf also stated that only 25% of monies paid out as premium to HMOs was utilized by them and even as they claim to have saved 450,000lives since the inception of the scheme, only a meager 1.5% of Nigerians are currently covered in the scheme.
“The 8th House of Representatives is the only House that has brought HMOs to account for their account. Despite the money paid out to HMos, our healthcare delivery in the country is still at its lowest. Other countries achieve better figures without HMOs. And After 12 years of providing services, these HMOs declared that 450 lives were saved.
“Besides using only a fraction of the money paid out to them, HMOs have only succeeded in increasing the number of enrollees (forgive me for using this word “Padding”). They are padding the figures so that they can get paid for people who are not enrollees”, Yusuf alleged.
The executive secretary further informed that the scheme under his leadership has discovered about 23 million ‘ghost enrollees’ even as it intends to ‘biometrically audit’ the HMOs to check their excesses. He added that of the 59 HMOs in the country, none had a valid license.
While calling on the House to remove HMOs from the board of NHIS as their membership undermines the regulatory function of NHIS, Prof. Yusuf asked that the NHIS Act be strengthened to enable it carry out its functions effectively.
Earlier, chairman of the House Committee on Healthcare services, Hon. Chike Okafor who stressed the need to for quality healthcare services decried the allegations that prompted the hearing adding that over 450 petitions have been received by the committee on the failure of the HMOs as well as inhumane treatment of enrollees.
Okafor stated that there is evidence that the scheme is at the threshold of failure and noted the need to put a stop to the brazen impunity of HMOs as well as other servicing organizations.