The Bahamas Insurance Association (BIA) is calling on the government to "rectify" actions of the National Health Insurance (NHI) Secretariat that seem to be in contravention of the very laws that brought NHI into force.
The BIA has concluded that the NHI Secretariat "presumably under the guise of purporting to act as the NHI Authority" has been acting as a regulated health administrator (RHA) "as defined in Section 26 of the NHI Act" in order to carry out the functions of NHI - though improperly.
"The BIA concurs with Health Minister Dr. Duane Sands' position that in the absence of a National Health Insurance (NHI) Authority board, actions taken to implement NHI, including enrolment and the execution of contracts with medical service providers were unlawful", the BIA said in a press release.
"We also agree with his view that the NHI scheme as it is currently being operated is susceptible to significant fraud, principally because it is operating outside its intended legal framework.
"We are concerned, however, that the identified breaches of the NHI Act and Insurance Act are ongoing and have not been addressed to date. One such breach of the NHI Act is that the NHI Secretariat may be acting illegally as an insurance company."
Sands said recently that the entire NHI scheme has to be redone, but made no mention of when the current scheme's actions might be stopped in order to carry out the retooling. He
admitted that the process would not be easy.
According to the BIA, the NHI Secretariat has been providing beneficiaries with access to benefits, paying providers for benefits, processing beneficiary claims, case management, and monitoring the provision of healthcare benefits. In these cases the secretariat has been acting as an insurance company does, but is not, among other things, registered with the Insurance Commission of The Bahamas.
"The BIA contends that the NHI Secretariat, acting on the premise that it can function as the NHI Authority (which has not been formally constituted), may have illegally taken on among other things the following functions of an RHA as defined in Section 26 of the NHI Act," the BIA stated.
"This would violate the NHI Act and as the secretariat would be carrying on insurance business, is also a violation of the Insurance Act.
"The recently reported complaints regarding non-payment of medical providers seems to illustrate one of the practical consequences of violating the law. Had an insurance company failed to make payment, a complaint could have been filed with the Insurance Commission, which has the legal power to investigate the complaint and to direct the company to resolve it. The insurer in question could also have been sued for breach of contract. Under these circumstances where the payments themselves violate law, the affected medical providers may not have any legal redress available to them."
The former government had talked about contracting an RHA to administer NHI benefits, but in the absence of one rolled out the scheme anyway.
"We submit that it is highly improper for the NHI scheme to be violating the very law that brought it into being," the BIA stated.
"We recommend that the government take steps to rectify this apparent disregard for the provisions of the NHI Act and Insurance Act. Additionally, the NHI Authority board when formally constituted, must take immediate steps to rectify the aforementioned breaches and ensure that the authority complies with the NHI Act and other applicable legislation."

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