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Published On: Mon, Jul 10th, 2017

How HMOs plotted NHIS boss’ sack

EMEKA EJERE |

Weeks after the Senate launched investigations into his activities as the NHIS chief, the Executive Secretary of the National Health Insurance Scheme (HHIS), Prof Usman Yusuf, was Thursday suspended, Minister of Health, Prof Isaac Adewale has confirmed.
Mr. Yusuf, 54, took over the state-run health insurance provider on July 29, 2016. But his reign has been fraught with allegations of fraud.
The lawmakers accused Mr. Yusuf of “corrupt expenditure of N292 million” which he allegedly spent on healthcare training “without recourse to any appropriate approving authority.”
The NHIS chief, however, denied any wrongdoing, insisting that the allegations against him were unfounded.
“Who told you I have been suspended or that I did any sharp practices? The person should come forward with proofs,” he said.
But multiple sources in the NHIS and the Health Ministry confirmed that Mr. Yusuf received his suspension letter Thursday evening.
Yusuf had, however, accused Health Maintenance Organisations (HMOs) of mismanaging N351 billion paid them between 2005-2016 for the provision of health services to federal civil servants.
Speaking at a recent investigative hearing by the Chike Okafor-led House of Representatives Committee on Health Services on the compliance rate of HMOs to NHIS contributors and utilisation of funds by healthcare providers, Yusuf insisted that despite the huge sums paid HMOs in 12 years, they failed to pay hospitals as at when due, and this resulted in majority of enrollees being treated shabbily.
He vowed to recoup the N3.5 billion debt owed hospitals by HMOs, even as he revealed that the weeding out of ghost enrollees will save the Federal Government N288 million annual payment for these fictitious patients.
He claimed HMOs have been padding the number of enrollees they have with the complicity of NHIS staff in the ICT department, led by a former General Manager of the department, who later became Executive -Secretary of the NHIS.
“This is not hearsay. This has been investigated by the Independent Corrupt Practices Commission (ICPC) and the Department of State Services (DSS), and the reports are there,” Yusuf said.
In response, representatives of HMOs denied the allegations made against them by the NHIS boss and said he had often displayed “open hatred” towards them.
But a mild drama played out as HMOs were represented by two different associations.
Dr. Lekan Ewenla, who made a presentation on behalf of Health and Managed Care Association of Nigeria, stressed that Yusuf lacked proper understanding of the administration of health insurance.
“From day-one he (NHIS Executive-Secretary) has been displaying open hatred to HMOs. All the issues he raised are really about NHIS poor implementation of its regulatory role,” Enwela said.
Dr. Ademola Aderibigbe, who spoke on behalf of 10 HMOs under the Association of Health Maintenance Organisation and Practitioners of Nigeria, argued that not all service providers have been fraudulent as members of his association have strived to be up to date with payments to hospitals.
On his part, National Chairman of the Association of Community Pharmacists of Nigeria, Dr. Albert Alkali, said the Federal Government is not blameless in the crisis between the managers of the National Health Insurance Scheme and Health Management Organisations in the country.
Alkali noted that NHIS managers had implemented policies that allowed corruption to thrive under the scheme. He spoke at a briefing in Lagos as part of activities leading to the ACPN 36th Annual Conference.
According to him, the global capitation method of payment gives room for funds to be embezzled by practitioners who want to cheat patients and other providers involved in the scheme.
He said, “Under the NHIS, one practitioner is given bulk payment to pay others. We know you cannot give a particular service provider money and expect him to give it to another service provider; he will want to retain everything.
“They had blocked the fee-for-service payment system that should have been the ideal method and this is why it failed. We should go back to the basis and straighten it, carry along all the health care providers and stop the sentiment of one provider taking everything.”
He said it was unnecessary to scrap the HMOs as suggested by the Federal Government, adding that their function was relevant to the scheme as they were the ones that sourced for enrollees.
Alkali said, “It is always easy to put the blame on HMOs but the NHIS that is supposed to play a regulatory role failed to uproot the bad eggs for it to serve as a deterrent to others.
“When the operators connive with the HMOs, they cannot carry out their regulatory role anymore and that is what brought us to where we are now. We want to move forward and Nigerians are tired of waiting, so both parties should fix the problem.”

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