The government has announced an investigation will be launched to determine potential abuse of the Public Service Medical Aid Scheme (Psemas), warning that those found guilty of abusing the system will face the full wrath of the law.
This comes after The Namibian reported in June that a Deloitte Namibia audit uncovered that the government disbursed N$1 billion for medical aid services to individuals supposedly affiliated with Psemas but who are not on the Ministry of Finance and Public Enterprises’ beneficiary system.
Finance spokesperson Wilson Shikoto said the government will be ‘fixing’ the Psemas system, which currently has 278 000 beneficiaries.
“Also, we would like to indicate that should there be any healthcare service provider, members or any other party who fraudulently benefited from Psemas, [they] shall face the full wrath of the law,” Shikoto said.
The ministry said the lack of integration between their data system and that of the Psemas administrator, Methealth, could have led to discrepancies in data in the two systems, thus appearing as if the N$1 billion was paid to non-existing beneficiaries.
The audit report called for an investigation into why a significant proportion of settlements (18% in 2020/21 and 15% in 2021/22) appears to involve members who do not exist on its Psemas members’ list.
“An investigation will be undertaken to fully understand the source of the data discrepancy and be remediated accordingly,” Shikoto said.
Shikoto said Psemas has recorded unsustainable expenditures at an escalating rate beyond common practices in the medical aid industry.
To address this, the government enlisted the services of a consortium of consultants with vast industrial expertise to provide actuarial and technical consultancy, including an examination into the benefits and contribution structure, Psemas tariffs and the overall governance and administrative model of the scheme.
Shikoto said the ministry has also been implementing short and medium-term administrative reforms to mitigate identified risks.
“This includes conducting a total membership re-registration aimed at data cleansing and eliminating possible ‘ghost members’. To date, 36 offices, ministries and agencies have completed this process,” Shikoto said.
According to Shikoto, up to this point, approximately N$13 million has been reclaimed over the years due to claims linked to discrepancies like fraudulent representation, unethical business conduct, misuse and excessive services rendered by healthcare providers.
Furthermore, an additional N$23 million has been recouped from individuals who were or are behind on their payments to the scheme, and a total of N$7 million has been retrieved from retirees who neglected to reapply for enrollment in the scheme after their retirement.
The ministry received the report in October from Deloitte after appointing it in January to conduct the audit.
Shikoto said since then, the ministry has developed strategies and an implementation action plan on the findings and recommendations.
Methealth was initially awarded the tender to dadminister the fund in 2010 for a four-year period, but during the last eight years no new tender has been awarded, with Methealth administering Psemas on an annual extension basis.
Deputy minister of finance and public enterprises Maureen Hinda-Mbuende in an interview with The Namibian recently said Psemas should be administered by government officials instead of private entities.
“What we need to do is reincorporate Psemas’ administration into the ministry of finance, and do away with paymasters,” she said.
“The contract of the administrator is about to lapse and should not be extended.”
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