The Health and Managed Care Association of Nigeria (HMCAN) has written the Executive Secretary of the National Health Insurance Scheme, (NHIS) Prof. Yusuf Usman, signifying its intention to commence a legal action against the executive secretary.
The HMCAN, in a letter by its lawyer, Mr. James Abasiakin-Ekim, of Grays and Gold LLP, has given Usman 30 days to reverse his policies, which it alleged were illegal.
The association, in the letter dated February 27, 2017 and titled, “Notice of intention to commence legal action,” noted that Section 2 of the NHIS Act establishes a governing council with the responsibility of managing and controlling the scheme.
It has added that Section 20 of the Act empowered Health Maintenance Organisations to carry out functions, including the collection of contributions and the payment of capitation fees.
HMCAN, the umbrella group of the HMOs in Nigeria, noted that the governing council of the NHIS had yet to be constituted by President Muhammadu Buhari. “The undue and illegal interference by your office has hamstrung the effective administration of the scheme as delayed and non-payment of capitation fees and fee-for-service will put the scheme in jeopardy.
The association alleged that the NHIS single-handedly negotiated a premium of one per cent and 0.80 per cent for indemnity insurance policies and appointed one insurance broker for all policies procured by the HMOs.
It said, “We wish to state that such an appointment and negotiation are illegal and ultra vires.”
Quoting Section 19 (2) (d) of the NHIS Act, the association stated, “The registration of an organization under the scheme shall be in such form and manner as may be determined from time to time by the council.”
According to the group, the section provides that the insurance company should be acceptable by the council.
It has said that an acceptable insurance company under the Act did not confer on the executive secretary “the power to negotiate payable premium and appoint an insurance broker and foist same on the HMOs”.
HMCAN alleged that all actions carried out by the executive secretary were “in excess of the powers” of his office.
The law firm, which wrote the letter on behalf of the association stated, “Having drawn your attention to the illegality of those actions, our clients implore you to immediately use your good office to correct those errors and misgivings as our client trusts that you also mean well for the scheme. “Take notices that if those policies pursued by you and complained of by our client are not reversed within 30 days from the date of this letter, we shall proceed to court to pursue our client’s right without further recourse to you.”
It said that the cause of action in the proposed suit would include alleged breaches of the NHIS Act by the executive secretary.
It has alleged that the executive secretary was unilaterally “usurping and excising the powers of the governing council of the NHIS” through the distortion of the payment of capitation fees and fee for service.

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