FCTA to sanction Health Management Organisations over unpaid healthcare fees

The Federal Capital Territory Administration (FCTA) has issued a stern warning to Health Maintenance Organisations (HMOs) under the FCT Health Insurance Scheme (FHIS), over failure to remit payments to healthcare providers.

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In a statement issued Tuesday by Lere Olayinka, Senior Special Assistant to the FCT Minister on Public Communications and Social Media, the administration said erring HMOs risk sanctions for delays in settling capitation and service fees owed to hospitals and clinics.

The FHIS is a social health insurance programme providing financial protection and access to healthcare for FCT residents.

While enrollment is free for FCTA staff, area council employees, and vulnerable groups such as pregnant women, other members of the public can join the scheme by paying a premium of N22,500 annually.

HMO is a network or organisation that provides health insurance coverage for a monthly or annual fee.

An HMO typically limits member coverage to medical care provided by doctors, hospitals, and other healthcare providers within its network, except for emergencies and out-of-area urgent care.

4billion released to cover backlog

The statement indicates that the FCT Minister, Nyesom Wike had approved the release of N4 billion to clear a backlog of payments dating from 2022 to 2024.

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It said this is part of efforts to improve healthcare delivery under the scheme.

The funds, according to the statement were disbursed between last year and this year to address delayed capitation and service fees.

“The Benefit Package of the FHIS includes the Basic Minimum Package of Health Care services (BMPHS) ranging from promotive, preventive, curative and some rehabilitative care services.

“The services include primary preventive care, screening, primary emergency services, and secondary level care such as dental, mental, eye, ear, nose and throat care, physiotherapy, surgeries, laboratory investigations, radiological investigations such as ultrasound scan, x-rays,” the statement reads

Despite this intervention, some healthcare providers have reported that certain HMOs continue to withhold payments, citing lack of bank details from hospitals, a justification the administration has described as unacceptable.

“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 statement reads.

Review and support for pregnant women

The administration also highlighted progress made in the scheme’s implementation over the past year.

These include: Full payment of outstanding fees dating back to 2022 by the end of 2024; Timelier capitation disbursement to HMOs; Upward review of capitation to improve healthcare delivery; Free enrollment for vulnerable groups, including pregnant women and children under five; and Accreditation of 100 Primary Healthcare Centres to expand access.

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“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.”

It also added that referral for secondary care including “caesarean section, blood transfusion, and treatment of other obstetric complications such as eclampsia, at all the 14 General Hospitals in the FCT is also provided at no cost to the patient through the BHCPF.”