RSSB: Fifteen medical facilities implicated in insurance fraud

Richard Tushabe, the Director General of Rwanda Social Security Board, during the news briefing in Kigali yesterday. Sam Ngendahimana.

Over the last three years, at least 250 subscribers to the medical insurance scheme RAMA and some 15 medical facilities like hospitals, clinics and pharmacies, attempted to abuse the system for their own advantage, Rwanda Social Security Board (RSSB) has revealed.

Speaking at a news conference in Kigali on Friday, Richard Tushabe, the RSSB Director General said that such entities were involved in medical fraud including billing for medical services that were never provided, some even duplicating medical bills from other health facilities.

“We have cases where a hospital copies a medical bill from another hospital and sends it here (to RSSB) for payment. For instance, a person goes for treatment to a hospital called Jacques and Sons. They are given prescription and drugs. Later, a same bill for the same patient is found at another hospital,” he said adding that this implies that the person is ‘treated twice’ [double medical bill], yet, in fact he/she was treated once.

He gave another scenario where a medical entity goes to a school and tell management to get all students that are affiliates of RAMA (medical insurance), and taken them to their clinic for consultation and treatment.

“In actual sense, this is fraud because the children are not ill; the medical establishment only does that to make money because RSSB will pick 85 per cent of the bill,” he said.

He added that RSSB is working with other government institutions to keep in check this kind of fraud before it escalates.

“We should scale up efforts so that we don’t lose the good services by government to its people because of few people who are driven by selfish interests,” he said.

However, RSSB was reluctant to provide details about the amount of funds that might have been lost from the fraud, arguing that the cases are still under investigation.

“We will give you details at the right time. At this moment, any details may jeopardize the investigations,” he said.

He said that the committee assess suspected medical bill to ensure that the claimed payment is genuine or not.

“The committee determines, through evaluation, whether the medical cost to be met should be accepted or rejected. When it is rejected, we let health facilities know the underlying factors,” he said indicating that about 10 percent of the bills are currently rejected as they contain mistakes.

“We should take stringent measures intended to curb the spending of public funds on services which have not actually been offered to members of the medical scheme as provided by the law.

He said that the body continues to assess the operations of its partners, and will not hesitate to sanction those which are not delivering quality services as expected.

On Friday morning, RSSB held a meeting with all pharmacies with which it has partnership so as to consider ways to improve medical services such as drugs they provide to Rwandans.

He urged them to shun malpractices and always call out those colleagues who go astray, saying that at the end of the day, it is the whole country that loses.

RSSB projected about Rwf47 billion in expenses on healthcare in a half-year period – July 2018 through December 2018, but, they rose to Rwf54.2 billion, indicating 14 percent more funds than expected, according to figures from the social security board.