The Tribune

By KEILE CAMPBELL

Tribune Staff Reporter

kcampbell@tribunemedia.net

NATIONAL Health Insurance payment delays are being driven in part by problems with laboratory claims and weak pre-clearance controls, Health Minister Dr Michael Darville said, as tensions continue between the government and healthcare providers over whether billing practices are contributing to the backlog.

“We did have some challenges, not so much with the physicians, but with the labs,” he said. “Sometimes there are discrepancies.”

Dr Darville’s comments came days after Prime Minister Philip Davis said the Ministry of Finance had flagged billing irregularities within the NHI programme and confirmed that a reconciliation exercise is underway.

The minister said irregularities sometimes emerge in how claims are calculated, and argued the system needs tighter, more efficient processing.

“Sometimes we find that there may be some irregularities on how that’s calculated,” Dr Darville said. “We need to be more efficient on how to do that, so that the system becomes a smooth operation.”

He said the pre-clearance process needs to be strengthened before certain lab tests are carried out.

“There is some challenges that we need to strengthen so that we could get pre-clearance before the labs are done,” Dr Darville said.

Dr Darville said the NHI framework sets out what services are covered, but said gaps in communication can lead to repeat testing.

“And it’s very clear on the NHI what can be done,” he said. “But sometimes there’s a lack of communication, where people think that you can just keep repeating labs.”

His remarks follow criticism from the newly formed National Health Insurance Providers Association, whose members accused the Prime Minister of casting doubt on doctors’ reputations after his comments about irregularities.

Dr Darville acknowledged the pressure on smaller providers waiting months for payments, but said he had raised the issue with the Ministry of Finance.

“I’ve spoken to finance for it, the response has been excellent,” Dr Darville said.

He defended the programme’s financial controls, saying firm limits are necessary to prevent costs spiralling.

“The programme is very tight and very structured, because if you do not have caps and riders on it, you will definitely have a program that is unsustainable,” he said.

The Tribune previously reported that doctors in NHI are paid through capitation and do not submit individual billing claims, while laboratory providers invoice through a separate system.

Dr Darville said work is continuing to make the process more efficient and ensure claims move through the system in a more structured way.