I always maintained that those healthcare providers who found nothing wrong to defraud PSEMAS should be likened to someone who removes the plug knowing well he/she is on life support.
The word fraud has become an economic giant in many business entities and I wonder where on this earth we are going to find the suitable remedy to address this kind of sickness- practise. I am particularly referring to the Public Service Medical Aid Scheme (PSEMAS) saga here in Namibia.
There has been speculation about both local and foreign health providers like doctors and dentists submitting fraudulent claims PSEMAS, health professional claim code that do not belong to their professional –for instance dental therapist claim as a dentist and medical practises open up new branches without informing the finance ministry yet they expect payments for the practices not mentioned in the signed agreement.
In fact, these speculations proved correct after the Ministry of finance probe into claims of fraud involving PSEMAS. One may ask the reason why finance ministry is poking its nose onto PSEMAS saga but I have learned that, PSEMAS is heavily assisted by this ministry and that is why a board of auditors has been appointed to manage and check the funds effectively.
Given the escalating healthcare costs, the sustainability of PSEMAS has come under increased pressure going forward. I also learned from the finance ministry that, the monthly expenditure for PSEMAS is about N$220 million given that the total number of beneficiaries amounts to 303766. This is unbelievable! Somewhere, somehow this is an epitome of mismanagement of funds alongside with fraudulent practices by other medical health providers who claims from PSEMAS.
Therefore, finance ministry left with no choice than to review the PSEMAS contract which will be implemented with effect from beginning of next month and obviously this move is meant curb the challenges I have mentioned already. It is for this reason that some health service providers are not going to find this new contract friendly and are forced to discontinue operations with the government. This is going to impact public health service too. Thus how fraud continue to be on the top list as enemy of the progress in any business entity and the economy at large.
One of the protocol of the reviewed contract from finance ministry states that, members of PSEMAS and health care service providers must sign in the specified claims when receiving health services from the health care service provider for submissions of claims. I hope this will help mitigate effects of fraudulent practice from corrupt practitioners who want to plough where they did not sow. What about those who are illiterate or do not understand fully medical terminologies, will it work? I understand that reviewing of contracts is not new to any business entity but my question and concern still stand as to whether this is going to be a solution to the problem?
It is well documented that some health service providers were caught on the wrong side during the investigation process. Is there any legal backlash tabled against them? If not then, I certainly conclude that Namibia is the only country where I have seen massive amounts of money went missing and no one is arrested for that! A good example to match this can be drawn from the Small and Medium Enterprise Bank (SME), lots of money went missing and no one face disciplinary action for that.
Why is the government of Namibia so light in dealing with fraudulent practices? Fraud is not a friend nor brother that one can treat with remorse. Fraud is an intentional act of deceit with the objective of gaining an unlawful advantage.
I wish to conclude that disciplinary action even law suit procedure is the best in handling evident fraudulent practices particularly this PSEMAS saga in a bid to discourage such practices and send a signal to the public in general about the bad side of it.
Itai Zviyita is a graduate of BA in Media Studies with Zimbabwe Open University.