Healthcare providers allegedly defraud PSEMAS

28 Sep 2017 20:40pm
WINDHOEK, 28 SEP (NAMPA) – The Ministry of Finance has put 36 healthcare provider practices who allegedly defrauded the Public Service Employees Medical Aid Scheme (PSEMAS) on hold.
Without revealing how much these practices defrauded the scheme at a media briefing here Thursday, the Chief Executive Officer of Methealth Namibia Administrator, Florian Amulungu said depending on the magnitude of the case, major fraud practices are put on 100 per cent hold of which no payment is done.
Amulungu explained that for medium cases, service providers are paid 64 per cent while investigations are ongoing.
“There are some major cases that were handed over to the Anti-Corruption Commission for investigations,” said Amulungu.
Amulungu noted that, recommendations were given to the Ministry of Finance not to give contracts to these service providers.
Speaking at the same event, Minister of Finance Calle Schlettwein said after the ministry picked up loopholes and abuses detriment to PSEMAS, all health professionals’ contracts with the scheme were reviewed.
Schlettwein emphasised that the main purpose of the review of the PSEMAS contracts was to address issues such as foreign doctors on working permits which were issued to work strictly for certain hospitals with no change allowed, but yet were signing private contracts with PSEMAS, thus claiming privately from the scheme.
Other issues included, health professional’s claims using codes that do not belong to their professions and health providers treating clients on PSEMAS who are actually not members of the scheme.
“Health professionals as gate keepers should ensure that the service is provided to legitimate beneficiaries (holders of membership cards),” said Schlettwein.
A total of 1 598 health care providers are registered in Namibia of which 1 111 are contracted in service providers with PSEMAS.
Healthcare providers will be required to sign a reviewed contract as from 01 October 2017 which will come into effect as from 01 November 2017.
Healthcare providers who will not sign the new contract with PSEMAS, will be forced to ask their clients to pay cash up front and claim later from PSEMAS themselves (the clients).