The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A well-known physician yesterday warned that the National Health Insurance (NHI) scheme could be exposed to “US-style fraud levels”, after the Government admitted the necessary IT system will not be ready for its January 2017 launch.

Dr Duane Sands, the FNM senator, told Tribune Business it would be impossible to protect the Bahamian taxpayer, and obtain ‘value for money’, without a proper information technology (IT) system providing the required “checks and balances”.

He was speaking out after the Government’s own NHI secretariat, in a document obtained by Tribune Business, admitted that a full IT infrastructure will not be ready for the $100 million primary care phase’s planned early 2017 roll-out.

The secretariat’s 11-page document, Frequently Asked Questions, sought to address numerous concerns raised by the Bahamian medical community, including when the necessary technology “to collect data on patient visits/risk profiles” would be in place.

In response, the NHI Secretariat admitted: “The IT infrastructure requirements are defined, and NHI is in the process of procurement and implementation of the system.

“However, it is expected that the full system will not be in place for the launch of NHI, and as a result a limited-function interim solution is being procured to support the launch.”

It is unclear what is meant by a “limited-function interim solution”, but the document acknowledged physician concerns that a health information management system was “essential for NHI to be successful”.

In reply, the Secretariat said: “The IT system being designed will easily integrate with other existing health information management systems.”

Dr Sands, though, told Tribune Business that a nationwide, properly functioning NHI primary care phase was “impossible” without a fully implemented IT system.

He added that it also exposed the Government’s long-planned healthcare reform to potential fraudulent activity by both healthcare providers and patients, as there was no way to validate claims submitted by the former or the latter’s doctor visitations.

“It’s going to be an interesting roll-out if we don’t have an IT infrastructure to make it work,” he said. “Without a robust IT system, how do you know who is providing what service to whom, and how often.

“It becomes an honour system from the patient point of view and the physician point of view. While I believe that most physicians are honourable men and women, not all are, and you’re opening up opportunities for the level of Medicare and Medicaid fraud that exists in the US.

“For the large part,” Dr Sands added, “you’re saying you’re not going to have the appropriate checks and balances to do what you need to do properly.

“They’re [the Government] going to spend $124 million in a whim and a prayer, quite merrily, to get this thing done.”

The Christie administration has allocated $100 million from the Government’s Consolidated Fund (existing tax revenues) to fund NHI’s primary care phase, plus a further $24 million to cover catastrophic illnesses during the initial roll-out.

Medicare and Medicaid, the US federal government programmes that finance healthcare for the elderly and low income earners, respectively, are both afflicted by fraud that has reached astronomical levels.

A US Government Accountability Office (GAO) report estimated that $60 million, or 10 per cent, of Medicare’s annual $600 million budget was lost to fraud in 2014. Media reports suggest that the situation at Medicaid, which has a $415 million annual budget, is not much better, with estimates suggesting that the two programmes could be losing a combined $98 million annually to financial crime.

Explaining how NHI could suffer a similar fate in the absence of a proper IT system, Dr Sands told Tribune Business: “If you show up to a doctor’s office, there is no way to verify that Suzy Smith is John Doe, and Dr Sands is supposed to be treating John Doe, not Suzy Smith.

“How, in the absence of such an IT system, will you make sure that the people’s money is appropriately spent, unless it’s supposed to be a free for all? I can’t see it working any other way.

“There’s no way you’re going to get a nationwide IT system set up, check it out and debug it between now and January. No way. It is totally impossible. I hope they understand they are playing with sensitive, clinical, patient data.”

Few in the Bahamian healthcare industry are likely to be surprised that NHI will not have a fully functioning IT system in place by the target January roll-out, given that there is just over three months left until the planned launch.

“The road to hell is paved with good intentions,” Dr Sands added on the IT system. “You may as well not waste time putting in place something to save the people’s money.

“It’s a free for all. Let everyone go to the doctor. Then you don’t have to pretend that you’re managing this system. There’s no way you can manage it. Imagine trying to audit this system in the absence of properly maintained records.”

Other core elements of the NHI plan are also behind schedule, including the selection of a private company to manage the proposed public insurer, Bahama Care.

Bids were supposed to have been submitted this month, but the Government’s own NHI website has now confirmed the deadline has been extended until November 7 - less than two months before the primary care phase’s roll-out.

This suggests that, like the IT system, the NHI public insurer will not be created, or operational, in time for the roll-out.

“After carefully reviewing requests for an extension from registered and potential bidders, the Government of the Bahamas has agreed to extend the deadline for the acceptance of bidder proposals,” a Government notice said.

“Accordingly, all proposals must be submitted on or before 3pm on November 7, 2016. The Government is seeking to select the best qualified company to manage the public insurer, and the best choice to provide Bahamians with quality services that will enable the provision of modern, affordable and accessible health care services.

“The Government of the Bahamas is confident that the extension will not impact the roll out of phase two of NHI Bahamas, which is enrolment.”