The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Bahamian doctors are accusing the Prime Minister of throwing their reputation “under the bus” with vague assertions about National Health Insurance (NHI) billing “irregularities” as the scheme falls up to two months’ behind in paying some providers.

Dr Denotrah Archer-Cartwright, a leading representative of the newly-formed National Health Insurance Providers Association (NHIPA), told Tribune Business that Philip Davis KC needs to “clarify” and fully explain what he meant by revealing that the Ministry of Finance had detected problems with NHI billings and payments.

The Prime Minister added that a reconciliation exercise is being undertaken to determine the cause of these woes, and anomalies identified by NHI executives, but Dr Archer-Cartwright said it was almost impossible for doctors and physicians to be responsible because they do not bill or make claims for payment on the government-run and financed healthcare scheme.

She explained to this newspaper that NHI providers are compensated using the capitation model, where they are paid a set monthly sum per patient regardless of how many times they see a person or the amount of care and treatment they require. Dr Archer-Cartwright said any billing issues relating to doctors “have to be something NHI is doing or allowing to happen” - not caused by the physicians themselves.

She agreed that the Prime Minister’s remarks threaten to damage the reputation of doctors providing services to NHI, but one healthcare industry source, speaking on condition of anonymity, suggested that Mr Davis was likely referring to laboratory services providers and not physicians. They explained that some laboratories may have been charging for services not required by a patient, or deciding the types and amount of tests needed themselves rather than acting on doctor recommendations.

Still, responding to Mr Davis’s concerns over billing irregularities, Dr Archer-Cartwright hit back by saying: “We don’t know anything about that, and why we don’t is because they don’t communicate anything. Doctors don’t bill NHI. This is why he needs to get more understanding and sit down with us because we don’t bill NHI. They have the power.

“They tell us who is on the patient list, they tell us what they are going to pay us and when they are going to pay us. We don’t even know when now. We haven’t heard anything on when they are going to pay us something. We’ve gone from a guaranteed date of payment to nothing…. And it’s the same capitation rate across the board regardless of whether the patient comes in. You can have some patients with lots of visits, some have less visits, so it balances out.”

One NHI doctor, speaking on condition of anonymity, confirmed that physician providers are still being paid the $12.50 per patient rate that they first received in 2017 despite the substantial rise in the cost of living subsequently and constant inflationary pressures. Asked about the Prime Minister’s “irregularities” concerns, they said: “We don’t know anything about that and what seemed to be a ‘throw under the bus’ thing to harm our reputation with the public when it’s their inadequacies that are causing the problems.

“We don’t bill; we have a slate of patients. I think everybody’s upset. There are people who won’t say anything because they are afraid of being victimised. We were paid on January 21 for the first half of December. We’re trying to organise and be involved with meaningful negotiations with the Government as an association. That’s the only way we can get through. They are shorting NHI, so they have no choice but to short us.”

The doctor continued: “I think the Prime Minister was using us and saying that we are doing irregular things. I think The Prime Minister was throwing us under the bus to ruin our reputation with the public.

“We don’t even bill NHI. NHI pays us according to the number of people who have signed up with us. We are never promised payment on a certain date any more. NHI informs us that they are working on it. And thank us for our patience, which we don’t have any more. I think some providers will get tired with inconsistent government payments and they will pull out of the scheme. The NHI signs contracts with the doctors every year but breaks the contract willy nilly.

“Added to that, there have been no increments in our income to cover the cost of inflation. Now the Government wants to claw back money from us to pay for the electronic medical records by charging us a monthly fee for using them. Also they also want to charge us for each doctor working in our offices,” they added. “We also have to pay twice for inspection of our offices, once by Hospital and Healthcare Facilities and secondly by NHI, and only NHI does an inspection.”

Dr Archer-Cartwright, confirming these and other concerns, suggested the real issue is that NHI lacks a sustainable funding model with demand from more than 160,000 enrolled Bahamian patients and associated costs simply overwhelming the scheme’s allocation of $48m in taxpayer funding in the 2025-2026 Budget - which itself represents a $2m increase on past years.

Revealing that some doctors are not being paid the capitation rate for patients who are clearly included among their NHI population, she said: “We can see someone two to three times and not get a dollar or cent, and ask for NHI to figure it out because you’ve seen the patient…. They’ve made things so confusing and so inefficient now that they are not having conversations with us to understand what is going on.

“They’re taking people off of lists without notice to the patient or doctors. We’re in a bad position. We have no information on what’s happening. We don’t know why they’re doing it. Who feels it? The doctors feel it and the patient feels it. The Prime Minister, we don’t know what he’s talking about and which executives are talking to him. He needs to clarify what he said.

“Doctors do not put in claims. Anything irregular has to be something NHI is doing or allowing to happen. It can’t come from us, the physician providers, because we don’t have the power,” Dr Archer-Cartwright added. “I do believe it has harmed our reputation, and this is why I urge the Prime Minister to give clarity and speak with the providers so that he can understand what is going on. We don’t know whether they are doing audits etc.

“We’ve seen the problems, and we don’t understand where they are coming from. For us, we’ve only ever been told that the Government never sent the money. It’s sitting there in the Treasury. They put in an allocation that is $2m more and, if they are not paying the providers, where is the money going every month? If you budgeted $48m, $2m more than last year, why every month can’t you pay everybody? That’s a big red flag to me, nothing to do with the providers.

“The scheme has really grown over the past three years. Were they not monitoring that? They added a lot of providers when they were struggling to pay their current providers. Why expand the programme? You know you are having financial issues but continue to expand the programme. Wouldn’t it be sensible to recognise that, take s pause, stabliise it and give the Government time to figure out how to pay for it while keeping the providers you have?”

Another healthcare professional, speaking on condition of anonymity, yesterday said they interpreted the Prime Minister’s comments as being directed at NHI laboratory services providers rather than doctors. Unlike the latter, they said laboratories bill for the services they provide to NHI via a portal which calculates what is to be paid to them.

“Labs may have been billing for services not required for that particular patient at that particular time,” the source said. “They were making decisions for that patient without the required recommendation from physicians as to what tests to perform. I think it was directed at them. I don’t think it was directed at doctors because, as providers, they are capitated. They are required to see the patient and document it in their records.

“I know they’ve taken steps in real time to correct that and changed the scope of services being provided to persons under NHI. The reality is I think the biggest problem with NHI is the sustainability of it. I’m not sure the model they have is sustainable. And with the new healthcare strategy how is that all going to integrate together and be sustainable?”