Since his appointment as Executive Secretary of the National Health Insurance Scheme (NHIS), Professor Usman Yusuf about a year ago, allegations of corrupt dealings have continued to dot the Agency unending. With a committee in place to investigate damning corruption claims, added to current happenings within the scheme, hope for an early resolution of the festering crisis looks a long shot to take. MUSA SIMON REEF reports on the conflicting signals distorting the Scheme’s operations in the last one year.
The National Health Insurance Scheme (NHIS), is gradually turning into a House of Putrefying Corruption, with the Minister of Health, Professor Isaac Adewole, empowering a panel to probe claims of financial improprieties and other allegations against the Professor Usman Yusuf-led management.
The committee, given a four-point Terms of Reference (ToR), according to an insider, has about four weeks to submit its findings.
Among issues being investigated by the ministerial panel are contracts splitting, appointment of new staff under the cover of secondment, and abuse of due process, especially awarding contracts running into hundreds of million Naira without adherence to extant rules.
NHIS’ insiders told Forefront that the committee’s report could mark a defining moment for the Scheme, established to provide affordable healthcare to Nigerians in the public sector.
Turning The Heat On Health Minister
But in an interestingly twist of events, a damning petition opening up yet another can of worms has been sent to the Economic and Financial Crimes Corruption (EFCC), with the Minister of Health, Professor Isaac Adewole and former acting Executive Secretary of NHIS, Mr. Femi Akingbade, allegedly being accused of corrupt dealings.
The petitioners alleged that both Prof. Adewole and Akingbade shared N1. 298 billion, as part of their booty for approving and paying the sum of N23.5 billion to Health Maintenance Organisations (HMOs), as approved in 2015 by the immediate past Minister of Health, Prof Onyewuchi Chukwu.
The petition, with suspicious vouchers of payment attached, by Concern Enrollees Network of Nigeria, and dated May 16, 2017, alleged that in his acting capacity, Akingbade, at the instance of the Minister of Health, allegedly paid the sum of N100 million for the purchase of two units of Range Rover jeeps. In the petition, whose receipt was acknowledged by the EFCC chairman’s office, the ex-NHIS boss is also being accused of purchasing a five-bedroom flat in Asokoro District of Abuja at a whooping cost of N400 million from the N1.298 billion loot they shared after paying the sum of N23.5 billion to HMOs.
Also, Akingbade is allegedly fingered as having lavished a whooping N2, 400,000 on fuelling a private jet from Abuja to Sokoto on March 9, 2016 for a national health meeting while purportedly tempering with numbers of those who enrolled in the NHIS inflating the figures and thereby diverting N1, 241,720,154.
Furthermore, the Minister, on his part, is accused of bribing some NHIS staff union members to the tone of N2,800,000 to cover up his track in the corruption allegations as well as wage a war of petitions against Prof Usman Yusuf, with a senior health ministry official fingered as arrow-head of the perceived massive fraud in NHIS.
The petition reads in part, “The former acting Executive Secretary, Mr. Akingbade paid 50% of fee for service to Health and Managed Care Association (HMCAN) in second quarter as arrears of fees for services from the year 2012 to 2015 with connivance to siphon NHIS funds. Also, HMCAN was alleged to have directed all their members to pay N9, 091,308.00, which Akingbade allegedly diverted for personal use”
Responding to Forefront text message, the former Acting Executive Secretary of the NHIS, Mr. Akingbade, debunked allegations that he bought a duplex for the minister of Health, Professor Adewole, describing the allegations as concocted and untrue. He challenged those behind the allegation to come up with evidence and prove their claims. He equally dismissed allegations that he bought two units of Range Rover jeeps at the cost of N100 million.
On accusation that he shared the sum of N1.2 billion with Professor Adewole as part of their loot for paying the HMOs the sum of over N23 billion, he described the allegations as figment of imagination of the accusers, saying that his bank account is available for scrutiny.
But findings by Forefront indicate that the petition against the Minister was allegedly inspired by a group loyal to Professor Usman. Worried by the avalanche of petitions already with the Presidency and the National Assembly, as well as their negative impact on the Scheme, Prof Yusuf’s group moved to throw up the alleged behind-the-scene maneuverings of the Health Minister as a distraction.
So, in a bid to stave off further attacks and prying eyes on activities of the NHIS management, the Yusuf-led team recently suspended further staff training as part of moves at cost reduction. But NHIS workers have come hard on the decision, describing it as a deliberate attempt at stifling the Scheme’s progress in terms of equipping them to perform their assigned responsibilities as captured in the NHIS’s service delivery mandate. Yusuf, who has been accused of spending hundreds of millions of Naira to finance ‘half-baked’ staff training, however debunked allegations that a firm, where he has interest, was engaged in contract splitting with a view to fleecing the organization.
Another allegations by Yusuf is that the Health Maintenance Organisations (HMOs), under the umbrella organization of Health and Managed Care Association of Nigeria (HMCAN), were engaged in corrupt dealings and fleecing the NHIS of billions of Naira. The Yusuf-led management also claims that it is currently facing hard times because of its resolve to end the culture of rot that has progressively been entrenched in the Scheme by some misguided elements.
Enrollees Allege Minister Mired In Corruption
Interestingly, the corruption allegations are not only restricted to the NHIS boss, as Health Minister Adewole is also fingered as a likely accomplice. Attempts by this magazine to get the Minister’s response to some of the issues raised in the petition, were declined as the he politely insisted that any issue relating to NHIS is kept in abeyance until the Committee comes up with its findings.
Against the backdrop of workers’ insistence that the Minister has refused to deploy his ministerial powers to deal with Yusuf, a top source at the NHIS declared that allegations against the Health Minister are fabricated, saying there is no iota of truth in the petitions whatsoever. The source debunked allegations that the Health Minister directed the former NHIS Acting Secretary, Akingbade to pay the sum of N10 million to a committee, saying there was no way payment can be made before the setting up of the committee.
According to the source, “Professor Adewole never directed the former Acting Secretary to pay the sum of N10 million to any committee. There were agitations, I am sure you know that. Then, the Minister directed that the NHIS should stop the secondment of people into the place without due process. The workers agreed over so many issues, and the Permanent Secretary in the Ministry of Health went there to hold a meeting, during which it was agreed that a committee be set up. The committee, thereafter, worked for about two weeks and came up with a budget of N10 million which the Minister refused to approve.”
On the payment of N2.4 million to fuel an aircraft that took the Minister and some Ministry officials to Sokoto, the source told this magazine, “What happened is that there was a Federal Executive Council meeting on a Wednesday, and there was also an important National health agenda the Minister had to attend to at the FEC meeting. When the meeting was finished, there was no flight to Sokoto, and the Ministry now contacted NEMA and asked for their assistance to take officials of the Health Ministry to Sokoto for a National Council on Health meeting. With no commercial flight scheduled for Sokoto, NEMA readily agreed and provided an aircraft with a condition that the ministry would provide the fuel. So, I can tell you authoritatively that it was NEMA plane that took the Ministry officials to Sokoto. NHIS only volunteered to assist in paying for the fuelling. At that instance, the Ministry could not process the cost of fuelling the aircraft because everyone was already in Sokoto for the crucial meeting”.
On allegations that a house costing about N400 million was bought for the Health Minister by the former acting Executive Secretary, the source described the allegation as a figment of the petitioners’ imagination, adding, “I can assure you that the Minister does not even have a plot of land in FCT. I challenge anyone who says otherwise to come forward and prove that Professor Adewole has a personal plot in Abuja. They are only trying to be funny by painting the man in bad light.”
Giving an insight on the frosty relationship between the Minister and some agencies under the Health Ministry, the source added, “The truth of the matter is that many of the agencies don’t revert to the Health Ministry as demanded by their rules’ book. The Minister has asked the Permanent Secretary to write and ask who approves their expenditure, due to the plethora of allegations trailing these agencies. Most of these health agencies have spending limits but they operate as if they are independent of the parent ministry, and it shouldn’t be so. Currently the Health Ministry is trying to streamline things, as the Permanent Secretary has written to them to submit all the approvals they have done.”
Reacting to claims that the Health Minister refused to approve the suspension of NHIS staffers accused of corruption, the source said, “I can say the Minister has at no time received a memo recommending that any staff be suspended and he refused to act. All we know is that Professor Adewole has set up a panel to probe series of allegations preferred against the NHIS boss. The committee has commenced work already and I am sure that very soon, the truth will come to light.”
HMCAN Unleashes Venom On Prof. Yusuf
Aggrieved by accusations of incompetence and corruption levelled against them by the NHIS boss, HMCAN, apart from heading to court to ensure justice for its members, also wrote to Acting President Yemi Osinbajo on the current state of the Scheme and the need to salvage it from which it described as the high-handedness of the NHIS boss, Prof Yusuf. In a petition to Acting President, Prof Yemi Osinbajo, dated May 12, 2017, HMCAN debunked allegations preferred against its members and accused Yusuf of carrying out an agenda that is inimical to the interest of NHIS.
According to HMCAN, “Since 2005 till July 2016, when Prof Yusuf was appointed, the Public Sector Scheme has been operating on the actuarial recommendations and the stakeholders’ joint communiqué of January, 2005 and June, 2005. Please see appendix 1 for verifications and authentication of the standard operational guidelines.
“Prof Yusuf started the disruption and distortion of the prepaid system by changing to post-paid system through the payment of capitation fee, fee-for-service and the administrative fee at the end of each due month and even introduced monthly payment instead of the quarterly payment at the beginning of each quarter.
“He single-handedly appointed and introduced one Northlink Insurance Brokers as the sole broker that would anchor the purchase of fidelity and indemnity insurance policies for all health maintenance organisations”, HMCAN protested.
Another alleged sin of Prof Yusuf, according to HMCAN, is that “he systematically embarked on instigation of primary health providers to indict health maintenance organisations of non-payment of capitation fees and fee-for-services. Letters from NHIS to health maintenance organisations mostly pronounced HMOs guilty which threatens (sic) to withdraw their accreditation.
“As at April 26, 2017, the General Manager, Standards and Quality Assurance of NHIS wrote all Health Maintenance Organisations requesting that each Health Maintenance Organisation should present a certificate of non-indebtedness from all the healthcare facilities being managed by each organisation. Please, find attached appendix iv for your attention.
“The fundamental issue here is that there are well over 8,000 accredited health facilities with a health maintenance organisation dealing with an average of over one thousand facilities. How possible can each organisation collect this letter on a quarterly basis.”
Calling on Osinbajo to set up machinery for a complete problem of the scheme as it relate to legal responsibilities of stakeholders, HMCAN appealed to the Acting President to investigate how Northlink Insurance Brokers was appointed by Yusuf as the sole broker for all Health Maintenance Organisations.
In addition, the forum declares in its petition: “We would suggest the investigation of his negotiation of outrageous premium of 1.00 percent and 0.8 percent for fidelity and indemnity insurance policies. We would suggest the investigations of all his claims in the Newspapers mostly especially allegations of corruption against all the HMOs, collection of N90 billion from the HMOs operating illegally and he should name the HMOs and where the funds are warehoused.”
The 5-page letter, signed by Chairman of HMCAN, Dr. Tunde Ladele, also called on the Federal Government to sanction accordingly all HMOs that are corrupt, just as the body appealed to the Acting President to probe the “deliberate incitement of health facilities against HMOs and false information about the conduct of the HMOs.”
Speaking to Forefront, Chairman of HMCAN explained why they took the NHIS boss to court: “We took him to court because when this scheme started, huge efforts went into setting it up. The international community encouraged the Nigerians involved to begin to drive private health insurance while we are waiting for government to start the public sector scheme. Because the ILO states that every employer of labour must provide for the medical needs of their staff, and what the FG is paying their staff today is what is due to them as medical allowance, 10% of their annual basic salary.
“So, we started private health insurance even before 2005. If we have a good regulator, a good ICT platform that will interface with the HMOs, I tell you there will be data to show the volume of private health insurance being run in this country. But those platforms were not created; instead the money was being kept and even squandered by some other people. So, for us, the issue is clear. We are not interested in who becomes the ES. Our concern is that the scheme should run. We took the NHIS Executive Secretary to court because when he came in, he didn’t create the platform to know the HMOs. He probably came with a mindset and he kept talking down and insulting the integrity of the HMOs. We felt belittled and we took him up for defamation of character.
“The other case is for distortion and destruction of the scheme. The scheme by design was to be prepaid. Nobody runs post-paid health schemes anymore. For us to make sure that this money goes seamlessly, it was agreed unanimously that this payment be done quarterly. It will be smooth as a prepaid scheme. At some point, the hospitals said they won’t treat enrollees anymore because of this reason-the funds were not being paid anymore and it distorted the scheme. This scheme was designed to eliminate paying from private pocket by the enrollee, and this was the level the thing came to. When he was appointed he claimed to be the ES of enrollees. If that was the case, he needed to do the needful-work closely with the HMOs. The law is there, anyone that misbehaves, there are sanctions.
“In addition to that, for every payment the NHIS provides advanced guarantee bond. That means if I need to give you one million Naira, I will provide 0.5% of that amount as bond to secure that payment. Even if an HMO fails to pay that money to the hospital, the payment has been guaranteed. It’s now left for the NHIS to instruct the insurance company to pay the hospital. There was no cause for the entire hullabaloo. It’s just because he doesn’t understand what to do and he keeps grandstanding, hence we took him to court.”
Senior Civil Servants Fight Back
Worried by subterranean ploys to undermine staffers of the Scheme, the executive members of the Association of Senior Civil Servants of Nigeria (ASCSN), NHIS Unit, recently debunked insinuations making round in some quarters that it was behind spurious allegations and petitions written against the management of the NHIS.
According to the NHIS workers, “That all the issues mentioned in the petition were captured in a petition that was written and signed by a particular group on 27th April 2017 and copied all anti-graft and security agencies including the President, HOS, SGF SSS, ICPC, EFCC, police, Senate, Reps, MOH, including our own union and we forwarded to the secretariat for appropriate action, the link was widely circulated. I am sure most of you got it.
“We have been favourably disposed to dialogue but have not been offered such opportunity as the ES refused to recognise the Exco and prefer to engage the services of bootlickers whom he is using against our elected representatives duly recognised by the National Secretariat.
“The ES said the Unit officials are working for some corrupt people he is fighting, but we have said it times without number that we are not against the war against corruption, but he should not use corruption to fight corruption by fragrant abuse of authority and non-compliance with due process, rules and regulations guiding public conduct. (secondment issue is still fresh in our memory) to say that no law stops him from raising any Seconded person from level zero to level 20 is a clear case of abuse of office. Transferring a well-trained officer out in order to pave way for recruitment to over bloat and frustrate our salary is not in the interest of our members”.
When Will Peace Return?
There is no doubt that the NHIS, as it currently stands, is engaged in a war with itself, with workers insisting that the management has side-lined the workforce to achieve its own motives. However, with the embattled NHIS boss claiming he is poised to rid the agency of alleged corrupt dealings foisted by the HMOs and few insiders, the waves of current transfer of staff to offices outside of the headquarters can only be a recipe for more tension.
Will the report of the ministerial committee established by Professor Adewole end the tense industrial relations between workers and the management? Will Prof Usman’s scheming to bring back the seconded staff he was forced to sack materialise?
These and many other questions are better left to the future to decide.