Doctor loses bid to access Govt medical aid scheme

THE Ministry of Finance on Friday won the first round of a courtroom encounter against a Katima Mulilo medical doctor accused of executing a virtual one-man raid on the Public Service Employees Medical Aid Scheme by claiming more than N$7 million from it last year.

The Ministry of Finance is accusing Dr CMJ (‘Kinnie’) Ward of dishonesty, greed, fraud and practising “conveyor-belt medicine” – charges which Ward has described as an attack aimed at sullying his reputation. Ward last year earned some N$7,058 million from PSEMAS alone, through claims that he submitted for medical services that he claimed to have provided to PSEMAS members.Ward, who is one of only two doctors with a private medical practice at Katima Mulilo, had an agreement with PSEMAS in terms of which members of the medical aid scheme did not have to pay the doctor for his services, since he could claim directly from PSEMAS.It turned out, though, that Ward was a very fast worker, whose practice did not only see patients moving through the consulting room at an unusually swift rate, but who also managed to register an above-average cost for each of his consultations with PSEMAS members.In the process, he claimed N$2,14 million from PSEMAS for consultation fees alone last year, and an added N$4,69 million for medicines that he dispensed.In contrast to the average of N$351,31 that a visit to a general practitioner in Namibia costs a patient, a visit to Ward was found to cost PSEMAS patients an average of N$503,04 last year, the Ministry claims.Given Ward’s claims record, the Ministry of Finance, though its Permanent Secretary, Calle Schlettwein, in May suspended the service-provider agreement that PSEMAS had with Ward.The agreement enabled Ward to claim directly from PSEMAS.Almost two weeks ago, after a further investigation of Ward’s practice, Schlettwein informed Ward that the agreement was being cancelled.This prompted the doctor to launch an urgent application before Acting Judge Simpson Mtambanengwe in the High Court in Windhoek on Friday to ask the court to order that the service provider agreement should be reinstated.Ward claimed that without being able to claim directly from PSEMAS, his practice might face financial ruin.Having heard some four hours of arguments from Ward’s lawyer, Herman Oosthuizen, and Government attorney Nixon Marcus, Acting Judge Mtambanengwe dismissed Ward’s case.He said that the doctor had failed to pass three hurdles that someone applying for an urgent interim interdict should first navigate.These are: to show that the balance of convenience would be in favour of granting the interdict, that the person wanting the court order would suffer irreparable harm if the order is not given, and that the person seeking the interdict would have no other suitable options that he could pursue in the long run.According to documents filed with the court for Friday’s hearing, Ward’s troubles with PSEMAS and the Finance Ministry started escalating after a report on his practice was submitted to Schlettwein in late April.After that report, and the suspension of the service provider agreement between PSEMAS and Ward, his practice was investigated further, with a fellow doctor, Andreas Obholzer, also submitting a report to the Ministry.Obholzer made some very serious charges.He stated that the average consultation time per patient at Ward’s practice lasted a little over three minutes.”This is conveyor-belt medicine,” Obholzer commented.”The accepted norm for good clinical practice is 10 minutes per consultation,” he added.Obholzer also reported that medicines prescribed by Ward were being dispensed by a nurse employed in his practice who, according to Obholzer, was not legally registered to dispense medicine.Furthermore, Ward was claiming consultation fees for follow-up visits on the higher scale of a first consultation, and was failing to charge PSEMAS members a five per cent levy on the cost of a consultation that PSEMAS requires, thereby prompting his patients to over-utilise PSEMAS and increasing his patient flow, the Finance Ministry claims.Obholzer’s opinion was sharp: “PSEMAS is forced to pay a standard agreed consultation fee for a sub-standard service and an illegally dispensed prescription.”The practice got away with this gross deviation from the accepted norm due to greed and a lack of checks and balances, until recently, by PSEMAS.”As if that opinion was not scathing enough, Schlettwein was even harsher.In an affidavit before the court, he stated that Ward had claimed and received payment for professional services that he did not perform.For that reason, the Finance Ministry is claiming N$6,27 million back from the doctor, who, according to Schlettwein, “had made himself guilty of fraud and/or dishonesty and engaged in dishonest business practice”.In responding affidavits, Ward said he had been providing a scarce service to the people of Katima Mulilo and the Caprivi Region, and now he was being blamed for that.Part of one affidavit reads: “I am not to blame for the general pathetic health care services in the Caprivi.I am not to blame if the vast majority of PSEMAS patients in the region prefer my health care instead of the other medical practitioners or that of the State hospital at Katima Mulilo.”The Permanent Secretary, he added, “should have considered the probability that PSEMAS patients view my medical services superior to the other”.Through the Ministry’s public statements about his practice, he also stated, “my reputation was seriously impaired and infringed”.Although Ward’s urgent application was dismissed with costs on Friday, he might return to court at a later stage, his lawyer indicated.Ward still plans to pursue a case in which he will ask the court to review and set aside the decision to cancel the service-provider agreement with PSEMAS.Ward last year earned some N$7,058 million from PSEMAS alone, through claims that he submitted for medical services that he claimed to have provided to PSEMAS members.Ward, who is one of only two doctors with a private medical practice at Katima Mulilo, had an agreement with PSEMAS in terms of which members of the medical aid scheme did not have to pay the doctor for his services, since he could claim directly from PSEMAS.It turned out, though, that Ward was a very fast worker, whose practice did not only see patients moving through the consulting room at an unusually swift rate, but who also managed to register an above-average cost for each of his consultations with PSEMAS members.In the process, he claimed N$2,14 million from PSEMAS for consultation fees alone last year, and an added N$4,69 million for medicines that he dispensed.In contrast to the average of N$351,31 that a visit to a general practitioner in Namibia costs a patient, a visit to Ward was found to cost PSEMAS patients an average of N$503,04 last year, the Ministry claims.Given Ward’s claims record, the Ministry of Finance, though its Permanent Secretary, Calle Schlettwein, in May suspended the service-provider agreement that PSEMAS had with Ward.The agreement enabled Ward to claim directly from PSEMAS.Almost two weeks ago, after a further investigation of Ward’s practice, Schlettwein informed Ward that the agreement was being cancelled.This prompted the doctor to launch an urgent application before Acting Judge Simpson Mtambanengwe in the High Court in Windhoek on Friday to ask the court to order that the service provider agreement should be reinstated.Ward claimed that without being able to claim directly from PSEMAS, his practice might face financial ruin.Having heard some four hours of arguments from Ward’s lawyer, Herman Oosthuizen, and Government attorney Nixon Marcus, Acting Judge Mtambanengwe dismissed Ward’s case.He said that the doctor had failed to pass three hurdles that someone applying for an urgent interim interdict should first navigate.These are: to show that the balance of convenience would be in favour of granting the interdict, that the person wanting the court order would suffer irreparable harm if the order is not given, and that the person seeking the interdict would have no other suitable options that he could pursue in the long run.According to documents filed with the court for Friday’s hearing, Ward’s troubles with PSEMAS and the Finance Ministry started escalating after a report on his practice was submitted to Schlettwein in late April.After that report, and the suspension of the service provider agreement between PSEMAS and Ward, his practice was investigated further, with a fellow doctor, Andreas Obholzer, also submitting a report to the Ministry.Obholzer made some very serious charges.He stated that the average consultation time per patient at Ward’s practice lasted a little over three minutes.”This is conveyor-belt medicine,” Obholzer commented.”The accepted norm for good clinical practice is 10 minutes per consultation,” he added.Obholzer also reported that medicines prescribed by Ward were being dispensed by a nurse employed in his practice who, according to Obholzer, was not legally registered to dispense medicine.Furthermore, Ward was claiming consultation fees for follow-up visits on the higher scale of a first consultation, and was failing to charge PSEMAS members a five per cent levy on the cost of a consultation that PSEMAS requires, thereby prompting his patients to over-utilise PSEMAS and increasing his patient flow, the Finance Ministry claims.Obholzer’s opinion was sharp: “PSEMAS is forced to pay a standard agreed consultation fee for a sub-standard service and an illegally dispensed prescription.”The practice got away with this gross deviation from the accepted norm due to greed and a lack of checks and balances, until recently, by PSEMAS.”As if that opinion was not scathing enough, Schlettwein was even harsher.In an affidavit before the court, he stated that Ward had claimed and received payment for professional services that he did not perform.For that reason, the Finance Ministry is claiming N$6,27 million back from the doctor, who, according to Schlettwein, “had made himself guilty of fraud and/or dishonesty and engaged in dishonest business practice”.In responding affidavits, Ward said he had been providing a scarce service to the people of Katima Mulilo and the Caprivi Region, and now he was being blamed for that.Part of one affidavit reads: “I am not to blame for the general pathetic health care services in the Caprivi.I am not to blame if the vast majority of PSEMAS patients in the region prefer my health care instead of the other medical practitioners or that of the State hospital at Katima Mulilo.”The Permanent Secretary, he added, “should have considered the probability that PSEMAS patients view my medical services superior to the other”.Through the Ministry’s public statements about his practice, he also stated, “my reputation was seriously impaired and infringed”.Although Ward’s urgent application was dismissed with costs on Friday, he might return to court at a later stage, his lawyer indicated.Ward still plans to pursue a case in which he will ask the court to review and set aside the decision to cancel the service-provider agreement with PSEMAS.