FCTA Warns Health Maintenance Organisations to Remit Payments to Healthcare Providers

The Federal Capital Territory Administration (FCTA) has taken a firm stance against health maintenance organisations (HMOs) that fail to promptly remit payments to healthcare providers under the FCT Health Insurance Scheme (FHIS). As a result, the FCTA will implement appropriate sanctions against defaulting HMOs. The FHIS is a social health insurance programme that offers financial protection and access to quality, affordable, and equitable healthcare to all FCT residents.

The FCTA has approved and paid about N4 billion in outstanding backlog payments for capitation and fee-for-service for years 2022 to 2024. This move is aimed at improving the quality of healthcare services provided to FHIS enrollees. The benefit package of the FHIS includes basic minimum package of health care services (BMPHS) ranging from promotive, preventive, curative, and rehabilitative care services. However, complaints have been received from healthcare providers concerning non-remittance of payments by some HMOs, with one excuse being that bank details of the hospitals were not available.

Key Takeaways:

• The FCTA has warned health maintenance organisations (HMOs) to promptly remit payments to healthcare providers under the FCT Health Insurance Scheme (FHIS), failing which appropriate sanctions will be meted out.
• The FCTA has approved and paid about N4 billion in outstanding backlog payments for capitation and fee-for-service for years 2022 to 2024.
• The FHIS benefit package includes basic minimum package of health care services (BMPHS) ranging from promotive, preventive, curative, and rehabilitative care services.
• Complaints have been received from healthcare providers concerning non-remittance of payments by some HMOs, with one excuse being that bank details of the hospitals were not available.
• The FCTA will monitor the compliance of HMOs to prompt remittance of payments to healthcare providers and commitment of healthcare providers to the discharge of their duties to FHIS enrollees.
• Implementation of the FHIS in the last one year has led to the payment of all outstanding capitations and fee-for-service backdated to year 2022 by the end of 2024, improved timeliness in the payment of capitation to HMOs, and review and increment of the capitation to healthcare providers for improved service delivery to enrollees.
• Free enrolment of vulnerable persons, including pregnant women, poor and indigents, has started enjoying healthcare services, and accreditation visits to 100 Primary Health Care (PHC) facilities have expanded the number of PHC facilities in FCT and improved access to healthcare services in communities.

Statistics:

• N4 billion: outstanding backlog payments for capitation and fee-for-service for years 2022 to 2024 approved and paid by the FCTA.
• N22,500: annual premium payment for non-public members to enroll in the FHIS.
• 100: number of Primary Health Care (PHC) facilities that have undergone accreditation visits to expand the number of PHC facilities in FCT.
• 14: number of General Hospitals in the FCT that provide free health education, medical consultation, and treatment to pregnant women under the Basic Health Care Provision Fund (BHCPF).

Sources:

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"FCTA warns HMOs to remit payments to healthcare providers", _The Nation_ (30 April 2024).

"FCTA clears N4b backlog payment to Healthcare Providers", _The Guardian_ (15 August 2023).