June 23, 2017

HMOs paid N60bn admin fee – Usman

Usman Yusuf

Yusuf Usman

By Emma Ovuakporie & Levinus Nwabughiogu
ABUJA — Executive Secretary of National Health Insurance Scheme, NHIS, Professor Yusuf Usman, said, yesterday, his office has paid N60 billion as administrative fees to  Hospital Management Organisations, HMOs, in the country.

Yusuf Usman

He, however, said the HMOs had a debt profile of N2.276 billion with hospitals across the country.

Usman made the revelations while responding to questions from the investigative hearing into the “compliance rate of the Health Management Organisations, HMOs, to the NHIS contributions and utilisation of funds by the health care providers and inhumane treatment of enrollees,” organised by the House of Representatives Committee on Health Care Services in Abuja, yesterday.

Describing the HMOs as “blood-sucking maggots,” Usman showed displeasure over the inability of the organisations to pay the medical care providers.

Usman, who also debunked the claims that the HMOs were in touch with the people, said: “When I came, I started asking questions no one asked. When I speak, I speak with data. It is not heresy. The issues are not now. We are holding the hearing because I am stepping on toes. I know what I gave the HMOs, each hospital, each place. I have the facts. HMOs are nothing but blood-sucking maggots.

“N60 billion is what we have paid them since 2005. This is people’s money. They are not everywhere because my men and women are in the field. They are not there. You come down from your hilltop and cash your cheque and you say you are everywhere. Everybody should serve where they are.

“HMOs, I am going to re-accredit you based on your performance and you are going to pay all.

“N2.276 billion is being owed hospitals by HMOs. For you to continue, you have to pay all the debts. For 12 years, 450,000 Nigerians only. We have identified corruption. Straight from our office, we will pay hospitals and save Nigerians.  NHIS should not be allowed to die in the hands of the HMOs.”

As an alternative, the NHIS boss said he would enrol over 2.5 million Nigerians into to the scheme, if he was allowed to deal directly with the service providers.

Speaking earlier, Deputy chairman of the committee, Muhammad Usman, stated the positions of  Nigeria Labour Congress, NLC, and its Trade Union Congress, TUC, counterpart on Wednesday, saying they would prefer a direct transaction with hospitals.

The TUC had called for the forensic audit of the HMOs to ascertain the true situation of issues.

Based on the positions, the lawmaker asked: “How can we cover the 180 million Nigerians using the NHIS? We are here for Nigerians and we want the NHIS to work.”

Also in his remarks, committee Chairman, Chike John Okafor, said:  “There are critical questions we’ve posed as part of what stared us in the face yesterday, which is that how do we satisfy the needs of the enrollees, and that must we have a third party payer HMOs? Will there be any problem if the hospitals are paid directly?”

He, however, said the committee would expose the erring HMOs, assuring that those living up to expectations would not be unduly punished.

Dr.  Mustapha Jibril, who represented Commissioners of Health in the 36 states, underscored the need to domesticate the scheme across the country.

“Currently, the role of the states is not being captured in the NHIS law and we are supposed to be in the scheme to domesticate NHIS by way of amendment to the current Act to capture the role of the state.”

“After listening to the HMOs yesterday, I would want to say that they were not able to defend their position with regards to allegations of capitation and admin fees which I think is a very large amount and the HMOs could not defend their position there”.

“We would like to see the HMOs given a different role to play in this, while they are also decentralised, since most of them are currently based in Lagos and Abuja with other state largely devoid of HMOs.

“It’s unfortunate to note that 12 years after, the scheme has been able to enroll just 1.5% of our total population.

“In countries where the health insurance scheme has been successful, the services of the HMOs have been eliminated. It has been practised in Ghana, Kenya, Rwanda and other places.

“Ghana set out on their health insurance journey 5 years ago, and record has it that they have achieved over 80 percent coverage for their population”, he said on behalf of state commissioners of health.

Speaking on behalf of the Association of Health Care Services Providers, Dr. Ugwu Ukachukwu Odoh called for proper implementation of the laws regulating the scheme for effective service delivery.

“In principles, concept and design, the Federal Government of this country put together a formidable NHIS for Nigerians to rescue us from poverty, health degradation, but at the end of the day, what do we have, we have a beautiful concept on paper but in reality, the reverse has been the case”.

“Any provider operating in less than any of these critical threshold is running at a loss. Over 95 percent of providers are simply subsidizing the health care of ordinary Nigerians.   Because we are uncommon businessmen due to our training to save lives.

“Today it is said that N351billion has been spent in the last 12 years, but I can tell you that trillions have exchanged hands under the table.

“HMOs have been allowed to become too powerful in the scheme playing the roles of both middlemen and service providers.’’

Speaking on behalf of the HMOs,  Dr. Tunde Ladele, who chairs a faction of the Association of Health Maintenance Organisatio,   blamed the NHIS for misrepresenting facts before the committee and Nigerians.

“70% of whatever amount quoted as being spent on the scheme goes to the service providers,’’ he added.

Another representatives of the HMOs, Dr. Lekan Ewenla, who served as the Publicity Secretary of the Association of Health Managers, accused the NHIS boss of high-handedness.

He said: “The current Executive Secretary of the NHIS went as far as appointing a single insurance broker for the HMOs as opposed to the list multiple brokers on their website from where HMOs choose brokers in the past based on preference”.

“He also went further to negotiate insurance premium on behalf of HMOs higher than what obtained without our inputs”, he alleged.

Meanwhile, a mild drama ensued in the course of the proceedings when the Committee Chairman randomly called an enrollee who later gave his name as Olalekan Ololoti to bare his mind on the performance of the scheme.

Narrating a story of how he assisted a pregnant woman at a private hospital through the HMOs service in Abuja during a national strike of public hospitals, the enrollee who said he was a pharmacist with the National Hospital, Abuja called for caution in the demands to scrap the HMOs.

Whom are we replacing them with?

The HMOs are doing their best. If there are no HMOs, what would have happened. When the public hospital went on strike. We should sit down and look at every side of it rather than calling somebody a bad name maybe because we don’t like their faces”, he warned.

His testimony sparked up commotion in the audience, occasioning many indications from participants who apparently wanted to counter the claims.

For over 5 minutes, the hall was agitated.

To calm the crowd down, the chairman of the committee gave opportunities for more testimonies.

This saw the coming of Hajiya Fati, another enrollee and staff of NHIS who shared her experience in a private hospital last week when her son was rushed to there.

According to her, the authorities of the hospital after diagnosis and prescription of drugs for her son told her to pay for the services.

When she cited NHIS as her cover, the hospital advised to buy the drugs from a pharmaceutical shop, assuring her that the HMOs don’t pay anymore.

She lamented the rot in the system, saying that she ended up treating her child.

This also caused another round of commotion, prompting the chairman to say “ believe you me, I am enjoying the exchange”.

But another enrollee who was given an opportunity to speak took a middle cause, saying that a holistic approach needed to be taken to overhaul the system.

“I want to ventilate my problem with the whole scheme. The pricing since 2005 has been very, very ridiculous. Whether it is NHIS or HMOs, We cannot recycle the money meant for drugs. Let’s have a hoilistic approach to this and overhaul the act”, he said.

The Committee is expected to submit their report at plenary when the House resumes on July 4.