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26th May, 2010
NHIA Moves To Check Fraudulent Claims
The National Health Insurance Authority is to establish a consolidated management claims centre to process the claims of teaching and regional hospitals to check abuse and fraudulent deals.
In furtherance of this, a consolidated premium account is to be established in July to ensure uniformity in the financial accounting and payment plan from service providers to enable the Authority to evaluate the performance of the scheme.
Besides, the Authority is to introduce prescription forms with identification numbers to expose bloated staff, expose abuse of free maternity care and the collusion of scheme and claim managers with service providers where men and not women have delivered through caesarian operation to dupe the system.
Mr. Sylvester Mensah, Chief Executive Officer National Health Insurance Authority made this known at a workshop in Ho yesterday on a new monthly reporting format for regional and district schemes and other data from the schemes for the period January 1 to April 30 this year.
He said the Authority had put in place stringent measures to review the contracts with service providers by passing a law to empower the Authority to commence prosecution of those involved in gross abuse, collusion, fraud and negligence towards the success and sustainability of the scheme.
“We have interdicted 36 scheme and claims managers and officers across the country while a number of them have been put before court and are in prison custody for gross abuse, fraud and negligence to collapse the scheme,” he said.
Mr. Mensah stressed the need for uniformity in financial reconciliation to avoid abuse, fraudulent and gross irresponsibility which must not be countenanced.
Mr. Joseph Amenowode, the regional minister, expressed concern about the spate of malfeasance which had bedeviled the scheme and was hopeful that issues affecting the sustainability of the scheme would be addressed.
He observed that the injection of efficiency would expose bloated staff, leakages, fraudulent deals and gross irresponsibility among the service providers, scheme and claims managers.
Mr. Elliot Akototse, regional manager of the scheme, attributed issues confronting the survival of the scheme to inadequate vetting of claims and weak financial management resulting in loss of huge sums of money to providers.
He called for the change of mind set to avoid collapsing healthcare financing mechanism, commitment from stakeholders with selflessness, compassion and empathy.
In furtherance of this, a consolidated premium account is to be established in July to ensure uniformity in the financial accounting and payment plan from service providers to enable the Authority to evaluate the performance of the scheme.
Besides, the Authority is to introduce prescription forms with identification numbers to expose bloated staff, expose abuse of free maternity care and the collusion of scheme and claim managers with service providers where men and not women have delivered through caesarian operation to dupe the system.
Mr. Sylvester Mensah, Chief Executive Officer National Health Insurance Authority made this known at a workshop in Ho yesterday on a new monthly reporting format for regional and district schemes and other data from the schemes for the period January 1 to April 30 this year.
He said the Authority had put in place stringent measures to review the contracts with service providers by passing a law to empower the Authority to commence prosecution of those involved in gross abuse, collusion, fraud and negligence towards the success and sustainability of the scheme.
“We have interdicted 36 scheme and claims managers and officers across the country while a number of them have been put before court and are in prison custody for gross abuse, fraud and negligence to collapse the scheme,” he said.
Mr. Mensah stressed the need for uniformity in financial reconciliation to avoid abuse, fraudulent and gross irresponsibility which must not be countenanced.
Mr. Joseph Amenowode, the regional minister, expressed concern about the spate of malfeasance which had bedeviled the scheme and was hopeful that issues affecting the sustainability of the scheme would be addressed.
He observed that the injection of efficiency would expose bloated staff, leakages, fraudulent deals and gross irresponsibility among the service providers, scheme and claims managers.
Mr. Elliot Akototse, regional manager of the scheme, attributed issues confronting the survival of the scheme to inadequate vetting of claims and weak financial management resulting in loss of huge sums of money to providers.
He called for the change of mind set to avoid collapsing healthcare financing mechanism, commitment from stakeholders with selflessness, compassion and empathy.
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