46 HMOs owe National Hospital N520m reconciled bills – Official

Abuja – An official of the National Hospital says 46 Health Maintenance Organisation (HMOs) are owing the hospital N520 million reconciled bills under the National Health Insurance Scheme (NHIS) as at September, 2019.

The official who pleaded anonymity in Abuja that HMOs owned the hospital a total of N1.7 billion unreconciled bills in the period under review.

“I want to tell you that the hospital has the highest number of patients under the scheme in spite the huge debt the HMOs are owing the hospital.

“We are not rejecting any referral because NHIS is a Federal Government’s initiative and National Hospital is working for the government.

“ It is alarming the rate some primary and secondary hospitals refer cases to us; cases they can handle but yet, we still treat them here.

“We receive referrals daily; we also take referrals from some private hospitals that have been suspended from the scheme; you can see that we have overwhelmed with the number of patients we handle,’’ he said.

According to him, National hospital has 31,000 patients receiving treatment in the hospital under the scheme.

The official said it was not encouraging with volume of debt the HMOs owed the hospital with this number of patients.

“Some private specialised hospitals accredited still do not perform their duty; they still refer cases to us which is not fair on their part.

“For instance, Caesarean Session (CS) costs N350,000 in private hospitals but it is N55,000 under NHIS so some of the private hospitals refer the case because of the low tariff from NHIS.

“We do the highest number of CS under the scheme; if we handle 10 Caesarean Sessions in a day, eight will be NHIS while only two pays.

“If we continue like this, we will not able to take care our bills,’’ he said.

In addition, he said the hospital had reported to the NHIS the challenge with HMOs and the NHIS has been supportive.

“The NHIS is taking it up with the HMOs and they have promised that if they do not pay, they will be paying directly to us.’’

On daily code introduced by the HMOs, he said, the process was too cumbersome for the hospital and the patients.

He said the hospital was giving code quarterly before and later to monthly, until the introduction of daily code.

The official said that the hospital needed to follow their instruction of daily code to be able to  reconcile the accounts with them.

Meanwhile it was learnt that Managed Health (Sunu) HMO is owing the hospital N25 million as at September 2019.

In his reaction, Mr Robert Ukeje, Branch Manager, Sunu HMO said he was not sure of the figure the HMO was owing National Hospital.

“I will check the exact figure we are owing them when I get to the office, even if at all, we are owing them.

“If they send their bill on time is another issue. If yes, we will pay them.

“We pay them monthly.  I am surprise the claim that we are owing them that much because we are going through a reconciliation period with the hospital.

“We are going through the reconciliation period with them to ensure that we do not own them anything.

“Besides, it is a continuous process. You cannot clear your debt the same time because the business keeps going,’’ he said.

According to him, they are two services under the NHIS- free service and capitation.

“What we cannot owe is capitation but as far as health insurance, free for service is grantee thing that you must owe. It is continues process.’’

In an interview, Prof. Mohammed Sambo, the Executive Secretary, National Health Insurance Scheme (NHIS) said some of the reasons that had resulted to owing was not attributed to NHIS.

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He saidt NHIS was not owing any HMO and was working to ensure that health facilities were not short changed.

Sambo said HMO was supposed to be paying health care facilities in turn, adding that there could be discrepancies as failure to agree on the reconciliation process.

“But what we are trying to do, we have taken the catalogue of old complaints and we are currently analysing those complaints by the healthcare providers and that is the first layer.

“After that, we will call for reconciliation and if the reconciliation is not possible at that level, we are even planning to employ the services of credible auditors and professionals.

“They will now go and take in depth reconciliation to ensure that nobody is short changed, if it is healthcare facility, if he has a genuine complain, we ensure that he is not short changed.

“If it the health maintenance organisation is the one that is right, we ensure that he is not put into serious pressure. So these are some of the things.

“ So reconciliation in the healthcare industry in not a new thing; when you go to even advanced countries you will see that the organ that is vested with the responsibility to reconcile are very big organs,’’ he said. (NAN)