News / National
Cimas licence on the line
14 May 2016 at 09:21hrs | Views
Cimas yesterday defied a seven-day Government ultimatum to pay health service providers' claims and instead, turned to the High Court seeking an interdict to stop cancellation of its operating licence. Government last week gave Cimas a one-week deadline that expired yesterday to comply with regulations governing medical aid societies in Zimbabwe or risk losing its licence.
Cimas, one of the largest medical aid societies, is accused of punishing its members by refusing to clear claims from service providers not on its prescribed list. Health and Child Care Deputy Minister Dr Aldrin Musiiwa confirmed the development, saying Cimas was offside as it still had to comply with the laws of the land.
"We have been saved with (court) papers where they are asking for an interdict to stop the ministry from cancelling the licence. We had not cancelled the licence, but had signalled our intention to do so in the event that they do not comply with the existing laws, but it seems they do not want to regularise but that will not save them."
According to Statutory Instrument 330 of 2000, medical members seek health services from any provider of their choice after which, the society has an obligation to reimburse at an agreed tariff within 60 days.
But according to Government, Cimas was selecting service providers and asking its members to pay cash to any other service provider not on its approved list and then request for a reimbursement.
Mr Musiiwa said this practice was unacceptable by law and worse still in the current economic environment, where people were struggling to survive. "The issues are very clear, they are cherry picking providers, which is illegal under Zimbabwean law.
"All health service providers are mandated by law to treat any patients who hold valid medical aid cards. If they fail to do that they are breaking the law and we have a right to prosecute them for failing to comply with the law.
"In the same vain, whoever issues a valid medical card in this country is mandated by the same law to pay for the treatment of their members within 60 days," said Mr Musiiwa.
He said Cimas was in violation of these laws and a number of service providers, which included pharmacies, Cooperate 24 and The Lancet reported them to Government – which is the regulator of medical aid societies in Zimbabwe.
Mr Musiiwa said although Government would wait for the decision of the court on the way forward, as the regulator, it will not allow a situation whereby patients ended up paying twice for a service as in the present case.
"Patients would have already paid their savings to a medical aid society through monthly contributions, so why should they be asked to pay again to access a service when they have a valid medical aid card. In all fairness, it is the obligation of the society to then pay up for services rendered to its patients and not the other way round," said Mr Musiiwa.
Mr Musiiwa argued that Cimas' reason for non compliance, which included suspicious claims made by the health institution did not hold water. He said some of the claims dated back to last year, yet the society was only citing a forensic audit now.
"If they suspected fraudulent activities they should have proved the fraud a long time ago then bring the evidence to the regulator but they just stopped payment and after they were reported 10 months down the line, they start saying we are having a forensic audit," said Mr Musiiwa.
In a recent notice to its members signed by Cimas' managing director Mr Roderick Takawira, the society said it had since instituted a forensic audit into claims submitted by Corporate 24.
"We believe that the outcome of the audit should determine whether or not Cimas resumes direct payments to Corporate 24. It is our expectation that the engagement with the authorities will lead to a resolution of this matter as member interests remain paramount to us," said Mr Takawira.
Mr Takawira said its dispute with Corporate 24 started when Cimas ceased direct payment to the society as a result of large number of suspicious claims.
Cimas, one of the largest medical aid societies, is accused of punishing its members by refusing to clear claims from service providers not on its prescribed list. Health and Child Care Deputy Minister Dr Aldrin Musiiwa confirmed the development, saying Cimas was offside as it still had to comply with the laws of the land.
"We have been saved with (court) papers where they are asking for an interdict to stop the ministry from cancelling the licence. We had not cancelled the licence, but had signalled our intention to do so in the event that they do not comply with the existing laws, but it seems they do not want to regularise but that will not save them."
According to Statutory Instrument 330 of 2000, medical members seek health services from any provider of their choice after which, the society has an obligation to reimburse at an agreed tariff within 60 days.
But according to Government, Cimas was selecting service providers and asking its members to pay cash to any other service provider not on its approved list and then request for a reimbursement.
Mr Musiiwa said this practice was unacceptable by law and worse still in the current economic environment, where people were struggling to survive. "The issues are very clear, they are cherry picking providers, which is illegal under Zimbabwean law.
"All health service providers are mandated by law to treat any patients who hold valid medical aid cards. If they fail to do that they are breaking the law and we have a right to prosecute them for failing to comply with the law.
"In the same vain, whoever issues a valid medical card in this country is mandated by the same law to pay for the treatment of their members within 60 days," said Mr Musiiwa.
He said Cimas was in violation of these laws and a number of service providers, which included pharmacies, Cooperate 24 and The Lancet reported them to Government – which is the regulator of medical aid societies in Zimbabwe.
Mr Musiiwa said although Government would wait for the decision of the court on the way forward, as the regulator, it will not allow a situation whereby patients ended up paying twice for a service as in the present case.
"Patients would have already paid their savings to a medical aid society through monthly contributions, so why should they be asked to pay again to access a service when they have a valid medical aid card. In all fairness, it is the obligation of the society to then pay up for services rendered to its patients and not the other way round," said Mr Musiiwa.
Mr Musiiwa argued that Cimas' reason for non compliance, which included suspicious claims made by the health institution did not hold water. He said some of the claims dated back to last year, yet the society was only citing a forensic audit now.
"If they suspected fraudulent activities they should have proved the fraud a long time ago then bring the evidence to the regulator but they just stopped payment and after they were reported 10 months down the line, they start saying we are having a forensic audit," said Mr Musiiwa.
In a recent notice to its members signed by Cimas' managing director Mr Roderick Takawira, the society said it had since instituted a forensic audit into claims submitted by Corporate 24.
"We believe that the outcome of the audit should determine whether or not Cimas resumes direct payments to Corporate 24. It is our expectation that the engagement with the authorities will lead to a resolution of this matter as member interests remain paramount to us," said Mr Takawira.
Mr Takawira said its dispute with Corporate 24 started when Cimas ceased direct payment to the society as a result of large number of suspicious claims.
Source - chronicle
