The Authorities of St. Mark Hospital, has appealed to the National Health Insurance Authority (NHIA) to rescind its verdict to suspend the medical facility from the National Health Insurance Scheme (NHIS), saying the decision was ill- informed.
Dr Mark Kurt Nawaane, Chief Executive Officer (CEO) of the Dunkwa-based hospital in the Central Region said the indefinite suspension of the facility was a grievous mistake which must be rectified immediately.
He contended that the decision by the authority to deduct Gh¢81, 502 from the hospital’s NHIS claims was also an arbitrary decision.
Speaking to the Ghana News Agency in an interview at Dunkwa, Dr Nawaane explained that on January 14, 2010, a three-man clinical audit team comprising a nurse, a pharmacist and an accounts officer from the NHIA visited the facility and scrutinised 130 bills of patients.
He said it came as a surprise to him when the NHIA announced that it had suspended the hospital due to the adverse findings of the clinical audit team, which claimed that the medical facility was, overpaid Gh¢81,502 between July- December in 2009 and had only one qualified nurse at post.
“The audit report was flawed and the conclusions drawn by the team baseless,” he stressed.
“How can one say that a big hospital like St. Mark has only one qualified permanent nurse. It is not true… It has never occurred in the history of this hospital since we started business in 1999.”
“In any case, the hospital has not been given an opportunity to answer any queries emanating from the clinical audit, how then do the NHIA slap a suspension on the facility?”
Dr Nawaane said the hospital had total staff strength of 65 including two permanent doctors, a part-time doctor, eight permanent nurses and 10 part time nurses.
He said the clinical audit team erred by not following the simple procedure for the assessment of staff strength as was spelt out in their working manual, such as the use of duty rosters, interview with the head of the facility and a head count.
The CEO said the claim deduction of Gh¢81,502 was not justified because patients’ receipts selected by the team for their study was done without a witness from the hospital.
Dr Nawaane explained that the team, which was auditing the hospital for the period under review, chose to select 130 patient bills from January to June 2009 purposely to discredit the facility, adding: “The discrepancies in those bills amounted to only Gh¢171.
“How can the NHIA justify the deduction of Gh¢81,502 when the real figure was Gh¢171?”
He said the hospital introduced a spinal anaesthesia with the assistance of a nurse-anaesthetist from the Dunkwa Government Hospital leading to the billing of patients between Gh¢1.68 and Gh¢2.60 for 40 operations carried out at the facility between October 10, 2009 and January 14, 2010. The drugs dispensed during the period totalled Gh¢171.
“St Mark Hospital reaffirms that it is not involved in institutional cheating.”
Dr Nawaane said the action by the NHIA had lowered Out Patient Department (OPD)attendance at the 60-bed facility by 80 per cent, leading to public outcry.
“We have received lot of complaints from the community. They are not happy that this facility has been suspended from the NHIS. We hope to work hand in hand with the NHIA to rectify the situation.
“This hospital belongs to the community and should be treated as such.”
The Matron of the hospital, Mrs Rosena Araba Hinson said before the suspension of the hospital from the scheme, the daily OPD attendance was about 300 daily because people in the community and surrounding areas preferred the services rendered at the facility.
Mrs Catherine Efavi, a patient at the hospital appealed to the authorities to quickly lift the suspension, adding: “ Although I can afford the cash and carry medical care currently in place, it is disheartening to see patients with NHIS cards being turned away.”
Mrs Patience Nawaane, Deputy CEO of the hospital said the suspension of the facility from the NHIS had compelled Management to lay-off about 30 members of staff.
Mr Peter Kofi Owusu-Ashia, Upper Denkyira Municipal Chief Executive said the action by the NHIA was unfortunate since people in the municipality depended heavily on the hospital for medical care and called on the authority to rescind its decision.