Leader of the Opposition Julian Fraser has indicated that he is not surprised there is now a major dispute involving operators of the state-owned National Health Insurance (NHI) and the Florida-based JIPA Network.
Under a contract signed in October 2015, the NHI was to be provided with access to JIPA’s already established network of healthcare providers throughout the Caribbean, Central and South America, and the United States.
NHI directors had stated that the move would have been cheaper for them, as they would not be required to search for healthcare providers on their own.
They were to pay JIPA each time they utilize healthcare providers within the JIPA network.
However, things recently took a dramatic turn, and JIPA is suing the NHI management for alleged breach of contract.
JIPA is reportedly alleging that the NHI has bypassed it, and has used the companies within its network without paying it (JIPA) the agreed fee.
Director of the Social Security Board which manages the NHI, Antoinette Skelton, has denied that any such transaction took place without JIPA’s involvement – as far as the contract is concerned.
And, now that the contract has been terminated, she is stating that the move will not affect the delivery of healthcare to NHI contributors.
The NHI/JIPA contract was not tendered.
A marriage that could not last
Meanwhile, responding to the latest development, Fraser, in a post on his Facebook page, noted that he had warned about the arrangement that existed between the NHI and JIPA.
“It was a marriage that could not last, and it’s not because it wasn’t made in Heaven. What was wrong with it, is that it was too rich for our blood. Say I told you, the cost of healthcare utilizing the services of JIPA came close to double that of the cost to the provider. Was that news to NHI? You can say that, after looking at responses to questions regarding JIPA’s rates,” he said on the weekend.
Back in October 2016, he had questioned Minister of Health and Social Development Ronnie Skelton about aspects of the contract with JIPA.
Fraser had asked the minister to state whether NHI considers JIPA a ‘middle-man for medical services and therefore the actual cost to JIPA is immaterial’.
He also asked the minister: “How is it that NHI accepts bills for payment from JIPA without knowing exactly what they are paying for?”
The health minister responded: “…In accordance with the terms of the agreement, payments to JIPA are calculated at 15% of the cost for healthcare services over $50,000 and 20% for services under $50,000 for patients cared for overseas where pre-packaged arrangements are made.”
“In respect of patients cared for overseas where there is no pre-packaged arrangement, payments are based on 20% of the cost saving. Additionally, there is a fee for administrative services that ranges between 2% and 8%,” Mr Skelton continued.
He explained that the services rendered to NHI beneficiaries are itemized on the invoices received from JIPA, including their procedure codes.
“The issue at hand is that JIPA does not itemize its administrative fees, but instead bundles them into each line item. For this reason, the NHI was not able to separate out the clinical charges from the fees charged by JIPA,” added the health minister.
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