The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Minister of Health yesterday admitted that the National Health Insurance (NHI) scheme’s “non-existent checks and balances” have left taxpayers totally exposed to fraud and other financial abuses.

Dr Duane Sands told Tribune Business it was impossible to verify the accuracy of bills submitted by medical providers and other suppliers because key NHI governance components have yet to be established.

Disclosing that there was little he could do in the short-term to remedy this, Dr Sands said he “can only hope” the scheme’s flaws and holes lasted for “a limited time”.

“Let me tell you, Neil, that yes, there have been concerns expressed, and I have concerns,” the Minister replied when Tribune Business raised the problems with him.

“If you think about it, the checks and balances that ought to be in place for NHI do not exist. You identified for me the inspectors doing the inspecting. Who is validating or verifying that the services being provided are provided, because there are no administrators.”

The Christie administration’s NHI model had this ‘administration/inspection’ role being provided by private Bahamian insurers and the proposed public insurer, Bahama Care. The latter has yet to be created, and may never be set up, while no health insurance company has agreed to act as a regulated health administrators (RHAs).

Besides paying NHI claims, the RHAs are also supposed to verify the accuracy of doctor and patient claims, ensuring payments equate to the services delivered. In their absence, Dr Sands said the NHI Secretariat is currently “playing the role” of administrator - a function it is not qualified or equipped to perform.

As a result, NHI and, by extension, the Government and Bahamian taxpayer, are potentially exposed to inflated provider claims for treatments never provided to patients - with no possibility to detect, prevent or take action against such behaviour.

“The potential for fraud clearly exists. To say fraud is going on, I have no way to say it is or is not,” Dr Sands told Tribune Business. “I can only hope the time of this unregulated disbursement of funds and provision of services is limited.

“Can I say categorically and convincingly there is no fraud? The answer is: No. Should there be inspectors, administrators and IT systems in place to ensure the people’s money is spent properly? I would say yes. When you ask me why is it not in place, an executive decision was taken [by the former administration].

“It’s like a plane taking off and there are no life vests on board. The captain said: ‘We’re leaving and everyone had better get in place. Everything will be going well’.... but if there’s a problem. You understand the metaphor.”

Tribune Business was yesterday told by well-placed sources that the Minnis administration has been “amazed” and “astonished” by the payment demands of some NHI providers, with cheques being written for sums as high as $30,000-$50,000.

Dr Sands declined to comment, but this newspaper was told that the absence of NHI “checks and balances” had left the Government powerless to resist paying out what one source described as ‘likely record sums’ for some practitioners.

The Minister was contacted after Bahamian insurers privately expressed concerns to Tribune Business that NHI was currently ‘wide open’ to various forms of fraud, including ‘double dipping’ where doctors could claim on both the Government-run scheme and private insurance if patients were enrolled with both.

With Bahamian insurers outside the NHI scheme, and no IT network in place to co-ordinate care and benefits, one insurer described the Government’s healthcare financing model as “a free for all” that threatened to impose an additional burden on the already hard-pressed taxpayer.

The insurer, speaking on condition of anonymity, told Tribune Business that the Bahamas Insurance Association (BIA) had warned the NHI Secretariat that the absence of an IT system linking all parties could facilitate financial abuse when they met recently.

“This was one of the major concerns we raised,” the source said. “Because the NHI Act was not fully brought into force, there’s no co-ordination of benefits, no enforcement tools and no legal provisions that speak to it.

“So it’s a free for all. Even if those provisions were brought into force, which they can’t do without the NHI Authority, there’s nothing there to check them. It’s a free for all. The risk of fraud is huge.”

The insurer told Tribune Business that under the NHI Act, persons enrolling in the scheme are supposed to disclose whether they already have private health insurance and provide details of the plan.

Those who have private health insurance have to exhaust this before they can access the NHI scheme, but the BIA and its members are questioning whether such information is being in the enrollment process.

“The NHI Secretariat is not talking to us, the insurers are not talking to them as to who has insurance,” the source confirmed. “So there is huge potential for double dipping.

“Those who suffer are the Bahamian people. We’re paying for all these services. If there’s double dipping, it’s not sustainable.

“And under what section of the Act do you seek to bring persons to account and go after them, when only Parts I and II have been brought into force? The legislative balances are not there for them to do anything. The medical provider contracts are potentially null and void if the persons entering into these contracts did not have the authority to do so.”

NHI’s lack of financial controls is especially alarming given the Bahamas’ ongoing fiscal crisis, led by recurring $300 million-plus annual deficits; a $7 billion-plus national debt; and debt-to-GDP ratio that will soon reach the 80 per cent threshold.

The Christie administration budgeted $124 million for NHI, but the scheme is currently being funded from the Consolidated Fund because monies were never properly sequestered for it. The Minnis administration has cut the scheme’s budget to $40 million for 2017-2018, with one-quarter of that to finance the NHI Authority’s creation.