Namibia PSEMAS medical aid scheme faces fraud allegations

The Public Service Employees Medical Aid Scheme (PSEMAS) is under scrutiny following allegations of fraud and systemic misuse. Prime Minister Elijah Ngurare has raised alarms regarding a potential cartel involving doctors and scheme insiders who may be working together to overclaim benefits. This comes as the government seeks an additional N$535 million to address the scheme’s funding requirements for the current financial year.

Former Finance Minister Calle Schlettwein suggested that implementing biometric verification could mitigate abuse by ensuring only eligible members and dependents access benefits. Schlettwein noted that misuse by medical practitioners, members, and healthcare institutions—such as serving non-members—has placed significant pressure on the fund’s sustainability. He highlighted that the migration of the ‘extended family principle’ has allowed many non-contributing individuals to benefit from the scheme.

Finance Minister Ericah Shafudah has described the current funding model as unsustainable. While the government has implemented initial reforms, including a governance council and benefit caps, additional budget adjustments are being made to stabilize the scheme. The total national budget appropriation has increased from N$87.9 billion to N$88.6 billion to accommodate these needs.