Nigeria’s National Health Insurance Scheme (NHIS) has given 23 Health Management Organisations, (HMOs) two weeks to comply with qualification requirements for which they were initially removed from the scheme.
This was the outcome of a meeting Thursday between the management of NHIS and representatives of HMOs, spokesperson of the scheme, Ayo Osinlu, said after the meeting.
“We had planned to officially release the names of the delisted HMOs in the national dailies but after this meeting we resolved to give them a second chance,” Mr. Osinlu told PREMIUM TIMES.
The NHIS Executive Secretary, Usman Yusuf, the 11-member governing council and its chairperson, Ifenne Enyanatu, and representatives of the 57 HMOs in the country all attended the meeting held in Abuja.
Mr Osinlu said the delisted HMOs were given two weeks to meet the scheme’s requirements.
“If after two weeks they do not meet up with our demands, they will now be finally kicked out of the scheme,” he noted.
Last week, NHIS announced the sack of 23 HMOs it said failed a validity test carried out on all the 57 HMOS.
According to the newly inaugurated governing council of the scheme, the HMOs failed to meet the minimum operational standard for the scheme.
Some of the criteria for accreditation of an HMO are registration with the Corporate Affairs Commission, adequacy of payoff share capital, current asset including fix asset, shareholders composition, company reserve, integrity of shareholders and composition of Board of Directors.
Others are that the company and its directors must have current tax clearance, appoint an audit fund, submit audit account to the NHIS as and when due, and comply with the Pension PENCOM Act, among others.
One of the criteria used as a critical irreducible minimum was the adequacy of payoff shares capital.
“The payoff share capital for National HMOs is N400 million, zonal coverage is N200 million and the state coverage is N100 million. And this is a critical requirement because the Payoff capital share of a company is a requirement for accreditation and evidence of their financial stability,” the chairperson of the governing council of the NHIS, Ms Enyanatu, explained.
“Only one out of the 57 HMOs actually scored 100 per cent and is therefore granted accreditation to operate,” Ms Ifenne, chairperson of the board, had said.
She had added that 34 HMOs were granted provisional accreditation until they fulfill all the conditions for re-accreditation, while 23 were delisted.
The NHIS spokesperson said on Thursday that the 34 HMOs granted provisional accreditation are also given two weeks to fully comply with the accreditation requirements.
All the representatives of the HMOs refused to speak with the press at the end of the meeting.
But an official of the agency who does not want to be mentioned said there is a lot of pressure and internal friction between the HMOs which they are trying to resolve.
NHIS deals with HMOs and Health Service Providers (HSPs).
The HMOs operate between beneficiaries of NHIS and service providers (hospitals), effectively making them managers of the scheme’s funds.
NHIS, as the regulatory body, monitors and regulates the activities of the HMOs and the service providers.
The HMOs were established in 2005 and had operated freely for 13 years without formal examination of their operations.
There have been complaints that the NHIS is unable to relieve Nigerians of their health finance burdens as a result of which people still largely spend out of pocket for health care.
No fewer than 450 petitions were sent to the National Assembly by frustrated Nigerians. The complaints ranged from lack of attention by hospitals, delayed attention, low drug dispensing to enrollees in the scheme and sometimes rejection of patients because of the inability of HMOs to meet their payment obligations to hospitals.
Calls for investigation into the activities of the scheme prompted a public hearing at the floor of the House of Representatives last June on how N351 billion was spent by the scheme since inception.
Mr. Yusuf, had at the hearing blamed the HMOs for the failure of the NHIS to deliver on its mandate.
He likened the alleged corruption by the HMOs to the fraud in the fuel subsidy scheme, stressing that enrolee figures were being padded.
But the HMOs refuted the allegations, blaming the several breaches in the implementation of the scheme on improper coordination and structural defects in the NHIS management.