NHIS payments: HMOs threatens legal action

The association also gave the scribe up to March 30 to redress alleged disruption and distortion of payments in the scheme or risk legal action

The Health and Managed Care Association of Nigeria has threatened legal action against the Executive Secretary of National Health Insurance Scheme, Prof. Usman Yusuf, over alleged abuse of office.
The association also gave the scribe up to March 30 to redress alleged disruption and distortion of payments in the scheme or risk legal action.
According to the counsel, Victor Abasiakan-Ekim, if the error and alleged illegality are not corrected on or before March 30, 2017, the HMOs will have no option than to seek redress before the court.
The ultimatum is contained in a petition served on NHIS by the counsel to HMCAN, Grays and Gold LLP, Legal practitioners and arbitrators.
A copy of the notice for legal action, which was received by the Office of the NHIS executive secretary on February 27, was signed by Abasiakan-Ekim and made available to the News Agency of Nigeria on Tuesday in Abuja.
In the petition, the association alleged that Yusuf had distorted and disrupted the capitation and fee for service payable to members of the association in accordance with the provisions of Act 35 of 1999, establishing the scheme.
Citing section 20 of the law, Abasiakan-Ekim explained that the National Health Insurance Act empowers the Health Maintenance Organisations to collect contributions from eligible employees under the Act as well as payment of capitation fees for services rendered.
He noted that the Usman solicited the assistance of the National Assembly to stop the payment and disrupt the payment of capitation fees and other fees payable to the HMOs.
He said the action of the executive secretary in tampering with the payment of capitation fees was illegal and ultra vires the powers as stipulated by Section 19(2)(d) of the NHIS Act.
The counsel, also pointed out that Section 2 of the NHIS Act, Cap N42 of the laws of the federation of Nigeria 2004, established a governing council saddled with the management and control of the scheme.
The governing council is yet to be constituted by the President and therefore the powers exercise by Usman was illegal and contravened Section 20 of the Act.
The counsel said: “The undue and illegal interference by Usman has hamstrung the effective administration of the scheme as delayed, non-
payment of capitation fees and payment for other services will put the scheme in jeopardy.”
Besides, he noted that the executive secretary exercise the powers of the governing council of the scheme when Yusuf negotiated the payable premium, appointment of Northlink Insurance Brokers limited and foisted the brokers on the association.
Abasiakan-Ekim added that the scribe single-handedly negotiated outrageous premium of one per cent for fidelity and 0.8 per cent for indemnity insurance policies.
He said Yusuf also appointed Northlink Insurance Brokers limited as the sole broker for all policies to be procured by the HMOs and healthcare providers.
The counsel said the actions were also illegal and contravened Section 19, Sub-section 2(d) of the NHIS Act.
Abasiakan-Ekim therefore advised the executive secretary to correct the errors and misgivings forthwith or force his client to seek legal redress.
Abasiakan-Ekim said: “We trust that you will use your good offices to address and resolve the issues raised by our client with a view to obviate the need for litigation which can be avoided.”
However, the counsel said that the Yusuf and the HMOs meant well for the scheme in their efforts to deliver affordable healthcare to Nigerians.
Meanwhile, the NHIS and Yusuf were yet to react to the petition even as NAN put calls through and sent SMS to the executive secretary.