Calle tackles PSEMAS mess …dismisses N$930m fraud claim, extends admins contract

Finance Minister, Calle Schlettwein has moved to address concerns surrounding the Public Service Employees Medical Aid Scheme (PSEMAS) detailing plans to achieve spending efficiency and quality of outcomes, so that reliable services are provided to the public broadly and at affordable prices.

Addressing PSEMAS stakeholders this week, Schlettwein announced that the contract for the PSEMAS Administrator (Methealth Namibia) is extended for 12 months, ensuring certainty of uninterrupted service provision.

Furthermore a portion of the new budget has become available to meet member needs and emerging claims which have been placed recently.

The budget allocated for PSEMAS for this financial year amounts not less than N$2.5 billion.

“We have noted with concerns about some service providers threatening that they would no longer be serving members of PSEMAS due to delayed payments. Such threats were not conducive to maintaining good relations,” further stated Schlettwein.

The Minister also dismissed as baseless, allegations of a leakage Draft IMF Fiscal Report alleging that an amount of N$930 million was defrauded on the Scheme per annum as there is no evidence pointing to such an amount. 

Looking ahead, Schlettwein noted that the concerns and inefficiencies raised about certain maladministration within the Medical Aid Division of the Ministry of Finance are being addressed. 

“There are some rotten apples on the part of the Ministry of Finance employees and some service providers. Suspected internal staff members from the Ministry were arrested through combined efforts with the Anti-Corruption. The staff members concerned allegedly registered non-public servants on PSEMAS system, thus defrauding Government. 

“More cases of non-public servants registered on PSEMAS system were discovered during audit process. These cases have been handed over to ACC against the staff members, who some of them has resigned from the public service. The aim is to enforce a zero tolerance against medical fraud, over servicing, abuse and profiteering through illegal, unfair and unethical financial dealings,” he said. 

The Minister also reiterated that as part of PSEMAS reform strategy, the Ministry will introduce the Biometric membership authentication solution as announced previously. 

“This is a triangular medical aid identification and administration system. The aim of the Biometric system is to drastically curb and minimize fraud. During this process, PSEMAS members and dependants will be re-registered physically and issued with a biometric smart card that are imbedded with member identification features. The Ministry has commenced with the procurement process of the Biometric system and envisage to start with the project in May/June 2019.”

He also highlighted that other challenges are with the PSEMAS contract that enable Health Care Service Providers to claim directly from PSEMAS. 

“It was noted with concern that some Health Care service Providers continue to provide service to PSEMAS members without PSEMAS contract and expect to claim directly from PSEMAS.  The Ministry has turned down many requests to backdate contracts with Health Care Service Providers because it is not in line with PSEMAS rules and regulations. Health Care Service Providers can only claim directly from PSEMAS from the date of approval of contract. To date, PSEMAS has contracted about 1087 Health Care Service Providers.”

Lastly, the Minister also admitted that PSEMAS has been faced with many challenges including fraud, abuse and wastage by some Healthcare Service Providers, the outliers as pointed out by the Peer Reviews conducted on Health Care Service Providers that revealed a number of Health Care Service Providers that have defrauded the PSEMAS Scheme.

“Against this background, a forensic investigation was carried out on a number of Healthcare Service Providers and results point to alleged medical fraud, over-servicing and abuse. Involved Health Care Service Providers will be conducted individually,” he said.