The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Minister of Health yesterday admitted that doctors' complaints about not being paid by National Health Insurance (NHI) are "unlikely to be the last" revelation concerning the scheme's woes.

Dr Duane Sands told Tribune Business that private doctors who had signed-up to provide services to NHI's 25,000-plus beneficiaries were "another potential casualty" of the Christie administration's haste to roll-out the scheme as a pre-election 'vote grabbing' tool.

Promising to speak with the NHI Secretariat about the alleged non-payment, the Minister reiterated that the failure to fully implement the NHI Act and its governance structure - especially the NHI Authority and its Board - meant the scheme lacked a lawful basis to make any payments whatsoever.

Dr Sands nevertheless said he had seen evidence of "a substantial amount of payments" made by NHI to private physicians, although he was unable to say whether the scheme was current.

Pledging that all doctors would be paid for "appropriate charges", the Minister warned that NHI will "no longer be given a blank cheque book".

Dr Sands was responding after Tribune Business received multiple reports that private doctors who had signed-up to provide medical care under were not being compensated for their work.

Dr Sy Pierre, the Medical Association of the Bahamas (MAB) president, confirmed he had been contacted on Friday by one such provider complaining about the non-payment.

"A physician called me today and said that they were not getting paid," he told Tribune Business. "For the last few months, they were getting paid on the 1st and 15th of the month, but he told me that none of the providers have been paid."

Dr Pierre said he was unsure whether this would result in NHI registrants being unable to access care under the scheme, should providers withhold services until they received payment.

And another senior doctor, speaking on condition of anonymity, told Tribune Business yesterday that NHI physicians had also complained to them about the scheme's non-payment.

"The cheque has not been processed because of these accountability issues, and the [Government's and NHI's] inability to verify bills being submitted and invoices for patients that don't exist," they said.

"There's no level of ability to verify and process. I don't understand it to be a money availability issue. They [the NHI Secretariat] are saying we have to figure out what's going on, who's seeing who and what services are being provided.

"You have this group of primary care physicians being paid to deliver these services. They're trying to figure out what to do now: Do they stop seeing NHI patients, or do they have to go to court to get money from the Government?"

Dr Sands confirmed to Tribune Business on Friday that the absence of vital "checks and balances", namely a comprehensive NHI IT system and regulated health administrators (RHAs) to verify the accuracy of doctors' claim submissions, had left the scheme as a "free for all" and wide open to fraud and other financial abuses.

The doctor told Tribune Business that the Minnis administration was now trying to 'apply the brakes' to this, realising that there was no mechanism to monitor doctor performance and patient treatment outcomes.

They added that the Government was also unable to determine whether the same patient was being seen by multiple doctors; if a patient was seen by a particular doctor at all; and if the identity and quantity of prescribed medicine was appropriate.

"They've never had this much money coming in during their entire existence ever," the doctor said of physicians who had signed up for NHI. "They're just raking it in.

"They're trying to see as many NHI patients as they can; five minutes, roll in and roll them out as fast as they can. This is what we warned about all along, and that $15 million [for primary care] will be gone in three months based on the stories I've heard about bills and invoices going in. I heard one practitioner submitted a bill for $55,000 for one week.

"This is not rocket science. We saw this happening. I don't know what they're going to do to fix it, but they'd better come up with a plan because it's going to get worse."

Dr Sands yesterday said he was unaware of NHI's physician payments schedule, but conceded: "I can say that in the absence of an appropriate governance and corporate structure there may be an impact on paying these things, because the law requires that certain things be in place.

"I have spoken a number of times about the challenge with NHI, caused by the premature roll-out of the programme. This is another potential casualty of the reality that exists.... I have expectations this is not the last matter that will be brought to the attention of the public."

He added that the 2017-2018 Budget had transferred responsibility for NHI payments from the Prime Minister's Office to the Ministry of Health, and any distribution of funds from the scheme's drastically-slashed $40 million financing had to "conform with the law".

Around 60 private doctors were said to have signed up to provide NHI primary care services under the Christie administration, and Dr Sands pledged that all will receive due compensation for bills properly incurred.

"Once the remedies are in place, much of this will fall away," he told Tribune Business. "Once we have the corporate and governance structure in place to legally pay our bills, we will do so.

"I have seen records of bills paid to providers, and a substantial amount of payments have been made. If we drill down into those payments, were they payables for April, May, June? I can't answer that question.

"What I can say now is that charges incurred by NHI have to be paid by the Ministry of Health through its NHI Head, and the Ministry of Finance and National Insurance Board (NIB) no longer will give NHI a blank cheque book," Dr Sands continued.

"A receivable is a receivable, whether it is paid a few days late, a few weeks late or 30 days late. It's still a receivable. If you are owed money for appropriate charges, those will be paid."

Dr Sands said the Minnis administration now "has to make some sense" of NHI, given that the Ministry of Health was largely not involved in decision-making and payments under the former Christie government.

"Decisions made have repercussions and consequences," he added, "and we are seeing the repercussions and consequences.

"I don't have the luxury of focusing on or lamenting over what has happened. It is done. As the consequences and issues arise, we will figure out how to deal with them."