10 Mar 2019 10:40am
WINDHOEK, 10 MAR (NAMPA) Since June 2018, the Ministry of Finance has recovered N.dollars 13.1 million from healthcare service providers for claims that were incorrectly and fraudulently submitted.
Finance Minister Calle Schlettwein made these revelations in the National Assembly on Thursday, when he responded to questions by Popular Democratic Movements Nico Smit.
Smit wanted to know how much the Government had lost through the Public Service Employees Medical Aid Scheme (PSEMAS) since independence and if measures have been deployed to curb the loss.
His questions follow media reports that PSEMAS is losing N.dollars 900 million annually due to fraud.
Schlettwein could not say how much Government has lost to date through the medical aid scheme and instead focused on what has been recovered.
The ministry has recovered N.dollars 13 062 734.08 since June 2018 from healthcare service providers for claims that were submitted incorrectly, he said.
Deputy Finance Minister Natangwe Ithete told Nampa they would have the exact figure of the financial loss on Tuesday.
Furthermore, a peer review process was conducted in April 2017 by Methealth Namibia Administrators to look at the PSEMAS crisis and 82 healthcare service providers were identified as 'out-layers' and recommended for further investigation.
Based on the peer reviews recommendations, forensic investigators were appointed to delve deeper into the PSEMAS mess for six months.
A section of the forensic investigators terms of reference reads that they were to support the Ministry of Finance with the development of forensic management framework and identify sanctions aimed at enforcing zero tolerance against medical fraud, over servicing, abuse and profiteering through illegal, unfair and unethical financial dealings.
From the 82 identified medical practices, forensic investigators could only attend to 29 cases due to data analysis and verification processes that were said to be time consuming.
From these cases, claims analysis for 11 practices were conducted and it was found that the current unlimited benefit for dental therapy was being abused.
To arrest this, limiting dental therapy benefits has been proposed.
At one pharmacy, it was found that staff members misappropriated cash payments for medicine dispensed to non-PSEMAS members.
A criminal case has been opened in this regard.
General medical practitioners also defrauded PSEMAS through unusually high tonsillectomy claims performed in hospitals as if they were performed in consulting rooms.
In addition, it was found that there were pregnancy-related claims for male patients, while claims for deceased person were also submitted by some medical practitioners.