THE Ministry of Finance has identified a list of 84 doctors who are accused of stealing millions of dollars through the government’s medical aid scheme.
The ministry has also instituted civil action against some providers and is contemplating slapping the alleged culprits with criminal charges.
At least N$13 million has been paid back to the state as some doctors are allegedly rushing to avoid charges.
This information is contained in a yet-to-be-published forensic report, which looked into the issue of fraud and the abuse of the Public Service Employee Medical Aid Scheme (Psemas).
The investigation was undertaken due to ever-increasing government medical aid spending, resulting in a 2017 resolution to investigate the claiming patterns of healthcare service providers.
Finance ministry spokesperson Tonateni Shidhudhu last month confirmed that forensic investigations were concluded in 2018. He said a peer review committee was set up, which identified a list of 84 doctors as outlayers, and it was recommended that they be investigated.
« Some contracts of the dishonest service providers were also terminated as they were found to be defrauding the system, » he said.
The finance ministry has not revealed how much has been lost through these scams, but a 2018 financial report by the International Monetary Fund (IMF) indicates the government has been losing about N$900 million per year.
The finance ministry disputes this figure.
Psemas currently has over 240 000 beneficiaries – 50 000 members fewer than in 2019.
The fund has received more than N$11 billion from the government since 2016. This figure is expected to reach N$13 billion in 2022.
Budget documents show that Psemas received around N$11,9 billion from the government between 2016 and 2020. At least N$2,5 billion is budgeted for the 2021 financial year.
Doctors and other service providers have allegedly found a way to milk this lucrative scheme.
In 2017, media reports indicate that service providers claimed over N$120 million from Psemas in less than 11 days.
One medical doctor allegedly claimed N$1,2 million during that period.
An investigation by The Namibian this month revealed that a once-off N$50 could earn one goods worth N$4 000 in a week.
« You pay N$50 to get a prescription letter from a doctor that would then allow you to claim goods through your medical aid. You can only do this once a week per medical aid to avoid being caught, » a source said.
These goods range from perfume to luxury lotions and footwear, among others.
« Many of these illegal transactions are mostly done when the Psemas [annual cycle] is about to come to an end. Pharmacies also advise clients to do this when their medical aids are about to be reloaded for the next financial year, » a pharmacist told The Namibian last month.
Several pharmacies were visited to better understand the possible abuse of medical aid schemes.
« Have you used your medical aid here before? You can take anything you want. We currently don’t have shoes here, because the people in Katutura are not interested in such expensive things. You can try that with pharmacies in town, » one pharmacist said.
Another suggested a customer could buy creams through the medical aid, but not shoes.
« I can’t sell you shoes here, because our stock is being monitored, but you can do that at other pharmacies. »
The finance ministry said it was not aware of the practice of medical aid members purchasing goods not permitted by the scheme.
« We would appreciate it if more details and information could be provided to us on these illegal and unethical dealings, » said Shidhudhu.
He said civil servants should avoid medical aid scheme abuse as the scheme is meant to support health-related needs.
« At a time when resources are limited we should, by all means, try not to abuse the benefits the government is providing us with, because one day the state may not be in a position to provide this, » he said.
Psemas is administered by Methealth Namibia, which has listed 1 306 service providers.
Fingers have also been pointing to Methealth, implicating it may have aided service providers in milking the government.
Chief executive officer of Methealth Namibia Florian Amulungu declined to comment on the matter last month.
« We have nothing to say, because all we do is assess claims and send reports to the Ministry of Finance, » he said.
Chairperson of the Medical Association of Namibia Dr David Weber said he is not aware that the finance ministry has instituted civil claims against doctors and some providers.
The ministry is now embarking on reforms aimed at stopping the abuse of government funds through Psemas.
During his 2021/22 budget speech in parliament, minister of finance Iipumbu Shiimi said Psemas is one of the areas that would be subjected to public service reforms, with results to be announced to the public.
Shiimi said a technical committee comprising public and private sector officials were assessing the scheme and proposing reforms for its optimal restructuring.
« The aim is to achieve internal cost savings and alternative modes of service provision, » he said.