Business Reporter
THE Ministry of Finance and Public Enterprises has said that it would not be accurate to conclude that there are numerous “ghost” beneficiaries in the Psemas system solely based on data discrepancies between the administrator Methealth and that of Finance.
The ministry added that an investigation will be undertaken to fully understand the source of the data discrepancy and address it accordingly. This comes after a Deloitte audit revealed that the government had paid N$1 billion for medical aid services to non-existent members who do not appear on the Ministry of Finance’s beneficiary system. However, Methealth Namibia, the private company managing the government’s Public Service Medical Aid Scheme (PSEMAS) since 2010, has denied these allegations. To date, N$13 million in fraudulent claims have been recovered.
PSEMAS currently caters to approximately 278,000 beneficiaries. Wilson Shikoto, spokesperson of the finance ministry, stated that over the years, PSEMAS has recorded unsustainable expenditures at an escalating rate beyond common practices in the medical aid industry. He noted that this continued unsustainable escalation in expenditure has necessitated a comprehensive and structural reform of the scheme.
“As part of the reform process, the government has engaged a consortium of consultants with extensive industry expertise to provide actuarial and technical consultancy, including an examination into the benefits and contribution structure, PSEMAS tariffs, and the overall governance and administrative model of the scheme,” Shikoto said.
He added that alongside the overall structural reform, the Ministry has been implementing short and medium-term administrative reforms to mitigate the identified risks. This includes conducting a total membership re-registration aimed at data cleansing and eliminating possible “ghost members”. To date, 36 Offices, Ministries, and Agencies (OMAs) have completed this process.
Shikoto mentioned that an amount of approximately N$13 million has been recovered over the years due to claims related to irregularities such as false representation, dishonest business practices, abuse, and over-servicing by healthcare service providers. “Furthermore, over N$23 million has been recovered from members who are or were in arrears with the Scheme. In addition, a total amount of N$7 million has been recovered from retirees who failed to re-apply for re-admission into the Scheme post-retirement,” Shikoto added.
He further noted that as part of the reform process, the Ministry initiated a Compliance Audit on the current PSEMAS Administrator (Methealth Namibia Administrators). Following a competitive procurement process, Deloitte Namibia was appointed in January 2023 to conduct the audit, focusing on assessing compliance with the PSEMAS Rules and Benefits structure. In October 2023, the Ministry received the final Compliance Audit Report, which includes management commentary and recommendations.
“The Ministry is addressing the Compliance Audit Report and has already devised strategies and an Implementation Action Plan based on the findings and recommendations contained in the Report. We have also engaged the Administrator on the same. However, we would like to emphasize that although the audit indicated a lack of integration between the MFPE data system and that of Methealth, resulting in discrepancies in data between the two systems, it would be premature to conclude that there are numerous ‘ghost’ beneficiaries in the Psemas system solely based on data discrepancies. An investigation will be undertaken to fully understand the source of the data discrepancy and address it accordingly,” Shikoto concluded.
