Concerns over HSA CAREPAY contract

The contract for the Cayman Islands Health Services Authority’s credit card billing system came under scrutiny during the Legislative Assembly’s Finance Committee Friday, with lawmakers asking how much was being spent on it and who the money was going to.  

The deal for the Real Time Claims Adjudication and Eligibility Verification System was approved by government’s central tenders committee in December 2010. According to CINICO’s annual report to government for the 2010/11 budget year, costs for the system were to be shared equally between the government insurance company and the health authority. 

“CINICO’s insured members would be given a swipe card [CAREPAY card] which would be presented at the Cayman Islands Health Services Authority at the time of service,” the annual report read. “The swipe card would enable instant verification of eligibility, benefits, provide ‘real-time’ adjudication of the claims and determine any patient out of pocket expenses, if applicable. 

“This would streamline the whole process at both the Cayman Islands Health Services Authority and [the] Cayman Islands National Insurance Company and significantly reduce the Cayman Islands Health Services Authority’s bad debts,” the annual report noted.  

The predictions in the 2010/11 annual report have not come to pass.  

The Cayman Islands Health Services Authority expects to have nearly $70 million in unpaid bills from services rendered to patients by the end of the upcoming budget year in June 2015, according to government financial records.  

The amount is referred to in the government’s 2014/15 budget ownership agreements as a “provision for doubtful debt,” meaning debts that have been owed for more than a year by clients of the health authority. If the projection of the additional unpaid bills occurs as finance managers expect, the Health Services Authority will have gone from having an estimated $45.8 million in unpaid receivables during the 2012/13 budget year to $69.9 million in the 2014/15 budget year.  

North Side MLA Ezzard Miller asked Cayman Islands National Insurance Company chief executive Lonny Tibbetts about the operating costs of the CAREPAY card system.  

Mr. Tibbetts said after the contract was signed, a $2.4 million “mobilization fee” was paid by the company, partly by CINICO and partly by the health authority. In addition to that fee, any successfully remitted healthcare claims will charge 1.5 percent of the value of the claim to CINICO and 2.5 percent of the claim value to the Health Services Authority, Mr. Tibbetts said.  

Mr. Miller asked if there was a local company or a local business license to which these charges were paid.  

Mr. Tibbetts said the contract was registered to “AIS Cayman,” which is part of Advanced Integrated Systems Ltd., based in Jamaica.  

Although Mr. Tibbetts made reference to a $2.4 million “mobilization fee,” Cayman Islands National Insurance Company financial reports for the 2010/11 budget year indicated that AIS Cayman Ltd. costs for implementing the system were US$1.372 million, not including travel and any additional consulting fees. Mr. Tibbetts later confirmed the actual setup costs for the CAREPAY card system were US$1.372 million, as stated in the 2010/11 annual report. He said he was “not sure exactly what [the $2.4 million] was for.”  

Finance Minister Marco Archer, chairman of the Finance Committee, intervened at this point, stating he would get a copy of the current CAREPAY system contract, and also request operating licenses and a register of beneficial ownership for AIS Ltd. 

“I want to find out who the ultimate beneficial owner of this company is,” Mr. Archer said. “There’s a lot of money being paid for this company and we don’t know who it’s going to.”  


The Health Services Authority’s credit card billing system is being reviewed by the Legislative Assembly’s Finance Committee.


  1. I think we need to take a closer look at the people associated with AIS Cayman and Advanced Integrated Systems (Jamaica) Ltd. to see if there are any connections to anyone at CINICO, the HSA, or the CIG. Also, how many companies were short-listed to provide these service during the tendering process?

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