The Ministry of Finance says the audit process of the Public Service Employee Medical Aid Scheme (PSEMAS) launched last year is still on-going, with 75 percent of the main members and 95 percent of dependents having been verified as part of measures to reduce fraud and abuse of the government employee’s medical fund.
The member audit comes as media reports attributed to the International Monetary Fund (IMF) revealed the medical aid fund has been losing close to a billion dollars annually to fraud, abuse, waste and collusion.
“During the first phase of the verification 95 percent of dependents were verified and those who do not meet the requirements were terminated whilst only 75 percent of the main members were verified and those who do not meet the requirements terminated however the process is still on going,” Ministry of Finance Spokesperson Tonateni Shidhudhu said.
“All dependents who turned 21 years and have not submitted their proof of registration for the current academic year are automatically terminated by PSEMAS through its administrators Methealth upon their 21st birthday as well as those that have exceeded the maximum age of 25 years and are not mentally/and/or physically disabled.
“However, those that are 25 years old and are mentally and or physically challenged can remain on the system provided that there is proof – a letter from the Ministry of Gender, Equality and Poverty Eradication that they are registered as beneficiaries of social grants accompanied by report from a Medical Doctor.”
Shidhudhu said all members; including non-contributing pensioners were terminated if their accounts were in arrears.
“Termination of membership is done on outstanding monthly premiums, which prompts the members to consult the Medical Aid Division upon discovering their termination and accounts are either settled in full or an agreement to settle the arrears is engaged in order to have the memberships re-instated. Non-contributing pensioners were terminated and informed of their arrears and once settled they get re-registered,” he said.
On efforts being made by the Finance ministry to control cost at the medical aid scheme, Shidhudhu said, “Government has commissioned a project to reform PSEMAS, outcome of which will be known by the end of 2020/2021 financial year. The reform will review PSEMAS rules and benefit structure, review PSEMAS governance structure and fiscal sustainability.”
Last year a peer review mechanism of the scheme which carries an estimated 290,000 beneficiaries identified more than 80 cases of suspicious activity attributed to service providers, including general health practitioners, dentists, hospitals, pharmacists and medical aid administrators.
Through the process, government recovered N$13 million; an additional N$23 million was expected to be recovered.