By Sarah NEGEDU
The Federal Capital Territory Administration, FCTA, has warned that sanctions await Health Maintenance Organisations, HMOs, under the FCT Health Insurance Scheme, that fail to remit payments to healthcare providers as and when due.
The warning follows persistent complaints from hospitals and clinics over non-remittance of funds by some HMOs, despite full payment of outstanding claims by the FCTA to the tune of N4 billion.
According to the Senior Special Assistant to the FCT Minister on Public Communications and Social Media, Lere Olayinka, the affected funds represent backlogs of capitation and fee-for-service payments from 2022 to 2024, approved and released by the FCT Minister, Nyesom Wike.
He said the excuse by some HMOs that providers had yet to submit bank details was not acceptable to the Administration and would no longer be tolerated.
Olayinka, in the statement disclosed that, “complaints have been received from some Healthcare providers concerning non-remittance of their payments by some HMOs, under the excuse that bank details of the hospitals were not available, an excuse not acceptable to the government.
“Therefore, compliance of the HMOs to the prompt remittance of payments to Healthcare providers, as well as commitment of the Healthcare providers to the discharge of their duties to the FHIS enrollees will be monitored with a view to sanctioning defaulters appropriately.”
The FHIS is a social health insurance programme designed to ensure financial protection through access to affordable and quality healthcare for residents of the territory. While enrolment is free for FCTA and Area Council staff and vulnerable groups, including pregnant women, other residents are required to pay a premium of N22,500 per year.
He explained that FHIS benefit package includes the Basic Minimum Package of Healthcare Services, BMPHS, which covers promotive, preventive, curative and some rehabilitative services. These range from primary and emergency care to dental, mental, eye, and ENT services, physiotherapy, surgeries, laboratory and radiological investigations.
Olayinka said the Wike-led Administration has, in the past year, ensured the payment of all outstanding capitations and fee-for-service claims dating back to 2022, improved timeliness in the release of funds to HMOs, and reviewed and increased capitation rates to healthcare providers.
He also listed the free enrolment of vulnerable residents especially pregnant women, under-five children, the poor, and indigents, as a major milestone, noting that many are already accessing services.
Additionally, accreditation visits have been carried out at 100 Primary Healthcare Centres, PHCs, in the FCT to expand the pool of facilities under the scheme and improve community access to care.
“Also, all pregnant women who enrolled through the Basic Health Care Provision Fund, BHCPF, Primary Health Care, PHC, Centres across the six Area Councils in the FCT will continue to enjoy free health education, medical consultation and treatment, routine antenatal drugs, laboratory investigations and delivery.
He added that referrals to secondary facilities, including for caesarean sections, blood transfusions and treatment of obstetric complications such as eclampsia, will also remain free at all 14 General Hospitals in the FCT under the BHCPF.
