Sylvester Mensah, CEO of NHIS
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13th May, 2010
NHIS Officers Interdicted
Two persons, Abdulai Yakubu and Abdulai Abu, Scheme Manager and Claims Officer respectively of the Gushegu Mutual Health Insurance Scheme, have been interdicted.
Their interdiction followed a clinical audit conducted by the National Health Insurance Authority (NHIA) into the operations of the National Health Insurance Scheme (NHIS) in the Northern Region which uncovered almost GH¢1.2 million in fraudulent payments.
Some health service providers have also been suspended.
Briefing the press in Tamale on the development, the Northern Regional Manager of the NHIS, Tanko Rashid Computer, said “service providers such as Bruham Clinic of Savelugu, Deahas Maternity at Lamashegu, and God’s care Clinic by the Nyankpala road have been asked to re-apply for new accreditation.”
He said six districts, East Gonja, Saboba/Chereponi, Gushegu, Savelugu/Nanton, Tolon/Kumbugu and Tamale Metro mutual insurance schemes were audited due to the high claims that were submitted for re-imbursement and the persistent threats by service providers to turn patients away due to the huge debts un-cleared by the scheme.
According to Mr Tanko Rashid, investigations revealed that some of the service providers connived with same employees of the scheme to either over-bill clients or faked claims and substituted tariffs of OPDs for in-patients, thereby, submitting huge claims which ended up in individuals’ pockets.
The Regional NHIS manager said “some items and drugs that are not on the dispensing list of the NHIS are submitted to the scheme for payments including cotton wool, glucose, gauze or even cheaper drugs like B-complex, paracetamol and Vitamin C.”
In the Gushegu and Tolon/Kumbungu Districts for instance, he said, the scheme uncovered that a man had undergone cesarean session, a medical operation which under normal circumstances only pregnant women will undergo.
Mr Tanko Computer said such fictitious deals had not only left the scheme to suffer financially but might as well collapse the NHIS in a shorter period than expected.
As a new measure, he said, the scheme was introducing a payment plan where claims will be scrutinized at the regional levels before payments were effected.
Their interdiction followed a clinical audit conducted by the National Health Insurance Authority (NHIA) into the operations of the National Health Insurance Scheme (NHIS) in the Northern Region which uncovered almost GH¢1.2 million in fraudulent payments.
Some health service providers have also been suspended.
Briefing the press in Tamale on the development, the Northern Regional Manager of the NHIS, Tanko Rashid Computer, said “service providers such as Bruham Clinic of Savelugu, Deahas Maternity at Lamashegu, and God’s care Clinic by the Nyankpala road have been asked to re-apply for new accreditation.”
He said six districts, East Gonja, Saboba/Chereponi, Gushegu, Savelugu/Nanton, Tolon/Kumbugu and Tamale Metro mutual insurance schemes were audited due to the high claims that were submitted for re-imbursement and the persistent threats by service providers to turn patients away due to the huge debts un-cleared by the scheme.
According to Mr Tanko Rashid, investigations revealed that some of the service providers connived with same employees of the scheme to either over-bill clients or faked claims and substituted tariffs of OPDs for in-patients, thereby, submitting huge claims which ended up in individuals’ pockets.
The Regional NHIS manager said “some items and drugs that are not on the dispensing list of the NHIS are submitted to the scheme for payments including cotton wool, glucose, gauze or even cheaper drugs like B-complex, paracetamol and Vitamin C.”
In the Gushegu and Tolon/Kumbungu Districts for instance, he said, the scheme uncovered that a man had undergone cesarean session, a medical operation which under normal circumstances only pregnant women will undergo.
Mr Tanko Computer said such fictitious deals had not only left the scheme to suffer financially but might as well collapse the NHIS in a shorter period than expected.
As a new measure, he said, the scheme was introducing a payment plan where claims will be scrutinized at the regional levels before payments were effected.
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