Namaf accused of 'extortion and coercion' tactics
The registrar of medical funds in Namibia may not approve rules that impose restrictions on payments to members of medical funds.The restriction follows a notice from the Namibian Association of Medical Aid Funds (Namaf) to healthcare providers in the private health sector that medical funds will deny direct claims on behalf of patients if they do not use the ICD-10 coding system.
The Namibia Private Practitioners' Forum (NPPF) has rejected Namaf and the funds' "extortion and coercion tactics" in a statement, saying it is "regrettable" that the registrar of medical funds has allowed this.
The NPPF, through its CEO Dr Jurgen Hoffmann, said it is the registrar's duty to ensure that all rules comply with the law and regulations governing medical funds.
"The newly imposed restriction does not comply with the regulations of the law," he said.
Hoffmann emphasised that Namaf has continued to ignore its statutory mandate to regulate medical funds since its inception. The association has also failed to establish conduct rules under which medical funds should be regulated, he added.
"Instead, Namaf continues to burden healthcare providers with endless requirements that are enforced in an illegal manner."
'Illegal restriction'
Hoffmann said the NPPF hopes the registrar appreciates that the illegal restriction on payments by medical funds has a direct and negative impact on members of medical funds.
According to him, Namaf's illegal actions coerce providers through extortion to incur costs and provide services for free.
The ICD-10 coding system is a standardised system used by some governments to code data on diseases and medical conditions. Since the data is valuable only to governments and health policymakers, countries using the system support and reimburse providers in the private health sector to assist government and policymakers.
In Namibia, however, this is not the case, and according to Hoffmann, the costs of training and the ongoing collection and submission of data – which represent a significant additional administrative burden – must be borne by providers in the private health sector.
"Since Namaf does not have the statutory powers to compel providers to use this system, it has now turned to medical funds to amend their rules so that no payment will be made to any provider who does not use the ICD-10 coding system," Hoffmann said.
Apply the law
He also referred to Namaf’s management, which consists of medical funds and is therefore "not in any way different from Namaf itself".
According to Hoffmann, the registrar of medical funds and the CEO of the the Namibia Financial Institutions Supervisor Authority (Namfisa) are believed to have already approved amendments to all funds' rules to compel providers to use the ICD-10 coding system.
The NPPF has "begged" the registrar to apply the law and take all necessary steps to ensure that the amendments to the rules enforcing the coding system on providers are promptly revoked.