By Dipo Olowookere
No fewer than 23 Health Management Organisations (HMOs) have been de-registered by the National Health Insurance Scheme (NHIS) for failing to meet up with the minimum operational standards expected of them.
Chairperson of the Board of NHIS, Mrs Enyantu Ifenne, while addressing newsmen on Thursday, disclosed that out of the 57 HMOS operating in the sector, only one scored 100 percent from the validity test conducted by the agency.
According to her, the only HMO that scored 100 percent has been given permission to operate, while the 33 others have been granted provisional accreditation.
She said these HMOs would only receive full accreditation when they meet all the conditions spelt for them.
All HMOs operating in the scheme are expected to renew their accreditation every two years.
Mrs Ifenne explained that the HMOs were scored based on aggregation of criteria and at the first cut, only 11 out of the 57 HMOs scored over 70 percent, 40 HMOs scored between 50 and 70 percent while 6 HMOs scored below 50 percent.
“The committee re-examined this and reduce the score further from 70 to 50 percent but only the Defense HMO fulfilled met most of the conditions.
“But if we apply the law, none of the 57 HMOs fully met all the NHIS requirements for accreditation.
“We have advised that the 11 HMOs that were recommended for provisional re-accreditation should comply with specific critical condition within two to three weeks before they can be fully accredited,” she said.
Mrs Ifenne further explained that the 46 HMOs who score below 70 percent were disaggregated depending on the critical condition they did not fulfil adding that the six HMOs which score less that 50 percent were removed from evaluation.
“That means they are not being considered for re-accreditation,” she said.
The NHIS chairperson said another score they 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,” she explained.
She also said HMOs were also required to submit their audited financial report from 2014 to 2016 but with criteria, six did not meet the requirements and one did not submit audited financial report and corporate affairs commission document, therefore removed from further consideration.
Mrs Ifenne gave some criteria considered for accreditation as; registration with cooperate affairs commission, adequacy of payoff share capital, current asset including fix asset, shareholders composition, company reserve, integrity of shareholders, composition of Board of Directors, current tax clearance of companies, current tax clearance of all Directors, appointment of audit fund and submission of audit account to NHIS as and when due, compliance with Pension PENCOM Act among others.
She charged the HMOs to do their business transparently and accountability while making profit, assuring them that the reaccreditation exercise was not meant to cripple any HMOs.
“With this shift, the healthcare providers will be held to account not only for the quality care but also for the humanity because from the information we have most in the scheme are treated as second rate patients.
“So, we all NHIS, HMOs and healthcare providers have to work so that the enrolle is at the tip of the value chain and the enrollee becomes the first in the universal coverage,” she said.
“We are going to redefine the processes and focus NHIS to stand up to its regulatory function. The failure to meet our regulatory function is the reason why this plague has being spread, not validated and no punitive action taking. We want to change that, we must change that.
“The HMOs as you can see are doing their best but they have not been regulated appropriately, we must apply the tools. They are willingly to subject themselves to regulations if we stand up to our duties.
“I don’t think any of them, except may be a few rascals want to ruin this game. Similarly, the healthcare facilities beam torchlight all the time. I believe that many of them would rather deliver quality service, they are in position to do just that,” she added.
On his part, Executive Secretary of NHIS, Mr Usman Yusuf, pledged that he will ensure that NHIS does the right thing moving forward and serve the people better.
“For a very long time, we have not being doing the right thing. I pledge as the Chief Executive of this agency, that I will do all I can to put the enrollee at the Centre rather than in the last position.”
He also denied the allegation of investing the fund of the scheme in business without due authorization, saying no Penney of the fund was invested anywhere in the country or outside the country.
Besides, he said the scheme has the right to invest its fund according to the law but it has not done that as the board has put a hold to the idea.
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