Govt medical aid mess
The precarious state in which the Public Service Employees Medical Aid Scheme (Psemas) finds itself in was this week exposed by this newspaper.
The report, seen by Namibian Sun, concluded that the lack of adequate internal control was most commonly cited as the factor that led to the abuse of the government medical aid by both service providers and members.
The rot at Psemas and Methealth Administrators is not new, as medical aid fraud has been on the rise in recent years.
The high levels of fraud, waste and abuse committed at Psemas have been uncovered following an investigation by a South African firm Savvy Solutions who was brought it in to focus on forensic audit investigations aimed at identifying and curbing irregular claim activities within the scheme to reduce costs and financial loss from fraud. The detailed report containing findings is damning, as it confirms the wide-ranging fraud, which fingered various service providers as well as members who are the main culprits.
The report, which took almost two years to complete, was submitted to the finance ministry in 2010, and shockingly nothing was done.
Today Psemas is struggling to pay medical service providers, amounting to over N$180 million, which has led to major disruptions. In the past few months, service providers such as general practitioners, pharmacists and specialists have started tapping into their reserves to pay their workers due to the non-payment of Psemas claims. Government had known since 2010 about the goings-on at Psemas.
However, a lax attitude toward governance prevailed, further worsening the situation. It is unacceptable that the authorities must come up with serious measures to reform Psemas even after spending millions on investigations.
Do we have to wait for things to spiral out of control before coming up with the remedial measures that detect and eliminate fraud and dishonesty?
The health sector is one of the most vulnerable in this country and we can ill-afford to continue to mess around with our taxpayers' money. Someone must take responsibility for a change and face the music.
The report, seen by Namibian Sun, concluded that the lack of adequate internal control was most commonly cited as the factor that led to the abuse of the government medical aid by both service providers and members.
The rot at Psemas and Methealth Administrators is not new, as medical aid fraud has been on the rise in recent years.
The high levels of fraud, waste and abuse committed at Psemas have been uncovered following an investigation by a South African firm Savvy Solutions who was brought it in to focus on forensic audit investigations aimed at identifying and curbing irregular claim activities within the scheme to reduce costs and financial loss from fraud. The detailed report containing findings is damning, as it confirms the wide-ranging fraud, which fingered various service providers as well as members who are the main culprits.
The report, which took almost two years to complete, was submitted to the finance ministry in 2010, and shockingly nothing was done.
Today Psemas is struggling to pay medical service providers, amounting to over N$180 million, which has led to major disruptions. In the past few months, service providers such as general practitioners, pharmacists and specialists have started tapping into their reserves to pay their workers due to the non-payment of Psemas claims. Government had known since 2010 about the goings-on at Psemas.
However, a lax attitude toward governance prevailed, further worsening the situation. It is unacceptable that the authorities must come up with serious measures to reform Psemas even after spending millions on investigations.
Do we have to wait for things to spiral out of control before coming up with the remedial measures that detect and eliminate fraud and dishonesty?
The health sector is one of the most vulnerable in this country and we can ill-afford to continue to mess around with our taxpayers' money. Someone must take responsibility for a change and face the music.
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Namibian Sun
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