Rotten to the core
Psemas has been in the red for the past four years and overspent its budget by N$484 million during the 2018/19 financial year.
02 April 2019 | Health
This is according to finance minister Calle Schlettwein, who said yesterday that Psemas is wonderful, but persistent fraud has rendered it unsustainable.
As a result, government will now look to private experts to assist it in transforming the fund without hurting civil servants.
It was also announced the fund will no longer be giving contracts to service providers using work permits in Namibia.
During his budget speech last week, Schlettwein announced that Psemas member contributions will be doubled from N$410 million to N$820 million a year, effective from this month.
He said yesterday fraudulent activities relating to the scheme are re-emerging, despite government's crackdown recently, adding the “rotten apples” must be dealt with at all costs.
Highlighting the extent of the fraud, he said “everybody was found with their hands in the cookie jar”.
“We must save Psemas; it may have to be abandoned if it can't be saved. We believe a collaborative (effort) is the best way to determine how the scheme is run in the future.” The finance minister pointed out the money one spends on one case of beer is equivalent to your Psemas membership fee for the higher option, while two six-packs of beer is equivalent to the fee for a dependent.
“It is by far the best medical aid scheme in the country. If we do not fix the problems the scheme will be under threat. We have to take stock of the administration of contracts, which is central to how administrators award payments,” he said.
Schlettwein said they have to work through a rather messy situation to fix the scheme and that it would be important to have a further peer review to get to a sustainable outcome.
“The red line for the state is that Psemas will lose its equalising ability. The scheme must provide equal service across all brackets. Psemas can become a role model in a country where inequality is high,” said Schlettwein.
According to Schlettwein N$13 million has been recovered so far linked to fraudulent claims, while a further N$28 million is also set to be recovered.
A trend analysis shows the scheme has been in the red for the past four years and overspent its budget by N$484 million during the 2018/19 financial year.
During the 2017/18 financial year, N$2.25 billion was budgeted, but its expenditure reached N$2.54 million, resulting in an N$270million deficit.
In the 2016/17 financial year the scheme recorded a deficit of N$461 million, while it overspent by N$510 million during the 2015/16 financial year.
This trend analysis was presented by Psemas deputy director Elizabeth Kharuxas.
It showed the scheme's 272 729 members contributed N$351 million during the 2015/16 financial year, while N$1.8 billion was contributed during the 2016/17 financial year when 290 040 beneficiaries were on the fund's books.
During the 2017/18 financial year the scheme had 303 149 members who contributed N$2.32 billion, while during the 2018/19 financial year the scheme membership declined to 296 637.
Kharuxas pointed out that the finance ministry will in the future reciprocate the hostile treatment it receives from healthcare practitioners, who refuse to see Psemas members because of late payment.
She added that some of the healthcare providers either apply late or did not have the required documents available.
She added that some service providers were found guilty of misconduct, adding that a disqualification clause and eventually a suspension clause will attached to claims.
According to Kharuxas, recent investigations found that multiple practices were claiming on one practice number.
“Mostly general practitioners (GP) are having multiple practices and bring in people on work permits who do not work for them. And with the current state of Psemas it is really unsustainable,” she said.
Kharuxas added some service providers operate under a close corporation and some of the partners are either their children or spouses.
She added the ministry will no longer give contracts to service providers who come to Namibia with work permits.
Investigations also found that some pharmacies take cash payments from private members and then charge it to random Psemas members.
The Psemas members have no clue this is happening.
Kharuxas said the scheme was literally being milked by service providers who subject patients to unnecessary services.
“As soon as a Psemas members walk into a doctor's consulting room they are prescribed medicine which is more than five scripts; he needs to go to physiotherapy, which is just next to the doctor's consulting room. Then he needs to go and draw blood which is not even necessary. We are taking a stand against all these,” she said.
Some private hospitals have also abused the scheme by admitting standard option clients without a recommendation from the Public Service Commission.
This money will be recovered, Kharuxas cautioned.
In some cases dependents over the age of 40 were still on the medical aid.
Meanwhile, the finance ministry terminated 17 000 dependents over the age of 21 years in June last year.
“The second phase that we are busy with is the ghost members on Psemas. These are public servants that have retired, and in some cases there were also some public servants who have been registered by internal staff to benefit,” she said.
The ministry has now enlisted interns 34 who will do a desktop audit review that compares Psemas data with payroll reports.