By Ndapewoshali Shapwanale
Finance Deputy Minister, Natangwe Ithete in late April said that the Ministry of Finance will need N$7,39 billion between 2019 and 2022 for a reform project of the Public Service Employee Medical Aid Scheme.
Ithete said this during his budget motivation speech for the Ministry of Finance on the Appropriation Bill.
Although the ministry’s spokesperson Andreas Ileka said that it is not known what the cost of the project will be at this stage, Ithete in the National Assembly broke down the amount into N$2.44 billion for the 2019/2020 financial year, N$2.37 billion for the 2020/2021 financial year and N$2.58 billion for 2021/2022 financial year.
The request for the PSEMAS programme funding forms part of a total allocation of N$13.18 billion for the different cross-cutting programmes over three fiscal years.
The cross-cutting that are administered by the finance ministry on behalf of the government, take up the greater part of the ministry’s budget vote.
The ministry has started with PSEMAS reform project, which according to their spokesperson, is aimed at enhancing the effective management and administration of PSEMAS.
According to the spokesperson, the ministry will implement a biometric identification system which is a triangular medical aid identification and administration system.
The introduction of the system is the ministry’s effort to curb and minimise fraud, which has drained the medical aid over the years.
The process involves the 297 000 PSEMAS members undergoing a re-registration process and the issuing of biometric smart cards that are imbedded with member identification features.
“This is to ensure that beneficiaries are positively identified; proof of presence is assured and medical expenditure is authorised in accordance with scheme rules and benefits,” Ileka said.
He added that the system will also harmonise and be interfaced with different systems such as Human Resources Management System (HRMS), Integrated Financial Management System (IFMS) and PSEMAS Administrator’ system.
The Patriot in February reported that the Office of the Prime Minister (OPM) paid N$14,8 million for a payroll and human capital system that later had to be discarded, because it was below standard.
The Patriot could not establish whether the financial and human resource systems have since been brought up to standard and are ready to be integrated.
“The Ministry has already started with cleansing the data, whereby we are busy conducting desk-top audit review.
This process is to verify the information on the government payroll against the reports from different Ministries, Agencies, and Regional Councils with PSEMAS membership data,” Ileka said.
The service provider has not yet been identified as the ministry is still busy with the procurement process as per the provisions of the Public Procurement Act 15 of 2015.
Despite the historic challenges that has cost the medical aid millions in fraudulent claims that also had to do with the misuse of the medical aid by those who are not members, the ministry said that they do not foresee any major challenges during the implementation phase.
“However, like with any other new systems, some hiccups might be experienced, whereby they will be address accordingly.”
Ithete in the budget motivation said with the introduction of the smart cards, the ministry anticipates to review a current piloted service provider contract and strenthening the audit capacity of PSEMAS.
PSEMAS deputy director Elizabeth Kharuchas earlier this year said the PSEMAS fund has been running on a deficit since 2016, with average yearly shortfalls of N$400 million.
Its budget amounts to N$8,5 billion over the four years from 2015 to 2019, with an additional N$1,7 billion to cover yearly shortfalls.
The fund was allocated N$2,4 billion in the 2019/20 budget.
Kharuchas said the largest chunk was spent on pharmacies, followed by hospitals and general practitioners.
Dentists presented the lowest bill of about N$15 million between 2014 and 2019.
PSEMAS Fraud Minister of Finance Calle Schlettwein in March this year said that the medical aid scheme lost up to N$900 million a year as a result of fraudulent activities.
There have been several reports on the fraud that has been taking place in the health sector that cost the government medical aid millions. Many healthcare practitioners and practices were suspected or accused of over-claiming from the medical aid plan. The Anti-Corruption Commission on 2 and 3 April this year arrested a Ministry of Finance employee and a billing officer at a private hospital for allegedly defrauding patients who were PSEMAS beneficiaries.
The medical aid administration officer at the ministry, Beatrice Boois and the billing officer Patience Mcavellem, were remanded in police custody after their first court appearance and are expected back in court on 29 May.
The arrests form part of the investigations of 82 health sector practitioners that were flagged for suspicious transactions.
Ithete told the National Assembly that the PSEMAS claims were subjected to a microscope exercise, resulting in some health care service providers, members and the administrator being thoroughly scrutinised.
The thorough scrutiny, Ithete said, resulted in millions being recovered from healthcare service providers and paid into State account, that by late April stood at N$13 062 734. This amount is part of the N$23 million expected to be recovered.
“Forensic investigations for healthcare service providers have resulted in two cases handed over to the Namibian Police for criminal proceedings, one case was heard by an arbitrator and one case currently being investigated by the Anti-Corruption Commission.
The PSEMAS screening exercise is ongoing and results will be announced once completed,” Ithete said.