NHIS recovers GH¢4.9m from 33 schemes

The National Health Insurance Authority (NHIA) has recovered GH¢4.9 million from 33 out of the 145 schemes across the coun­try following the forensic audit commis­sioned by the authority last year.

The audit into the operations of the remain­ing 112 schemes is ongoing to help recover the money allegedly lost through fraudulent means at the scheme level through claims ver­ification and payments submitted by service providers.

The findings and assurances are contained in an internal report released this week by the authority concerning its challenges and achievements in 2009 and 2010.

The report noted that the clinical audit had enabled the authority to identify scheme offi­cials who were engaged in financial malpractice and fraud to face the rigours of the law.

According to the document, a number of scheme staff had also been interdicted, sus­pended or dismissed as a result of the work of the clinical and financial audits as a way of instilling financial discipline into the opera­tions of the authority and the schemes.

It said the suspicion of fraud was height­ened by the fact that in 2008 GH¢165 mi11ion was spent on claim payments country-wide, rising to GH¢372 million in 2009, represent­ing an 81 per cent increase.

“This type of expenditure could not be sus­tained into the future. Management, therefore, decided that if nothing was done to verify the reasons for and sources of the exponential increment in claims cost and contain them as soon as possible, it would spell the doom of the NHIS,” it said.

It also indicated that part of the reasons for the problems that nearly collapsed the NHIS was the failure of the NPP administration to make available to the NHIA proceeds from the National Health Insurance Levy, which had accumulated to GH¢115 million by December 2008.

It said as a result of that, service providers lost trust in the ability of the schemes to fulfil their part of the bargain, which meant that they must be paid within the 90 days period as stip­ulated in Act 650.
.
It said another problem was the increasing trend of claims, saying to address that, it had established a consolidated Claims Processing Centre (CPC) which became operational this year.

It commended The Netherlands govern­ment for providing €750,000 for the establishment of the CPC which was dedicated to the processing of claims from the 10 regional hos­pitals and three teaching hospitals in the coun­try.

The document noted that the CPC had led to a reduction in the time for vetting claims and at the same time eliminated fraudulent claims, adding that plans were far advanced to replicate the CPC at the zonal level to take care of the regions to improve the vetting and payment of claims country-wide.

It said it had also introduced new standardised NHIS prescription forms to be used in all NHIS accredited healthcare facilities in the country and explained that that new facility required the personal identification number (PIN) of the prescriber and the dispenser and also identified the scheme involved.

It said it had also finished work on the amendment to the Act 650 to streamline the activities of the 145 schemes which had 118 different legal and administrative bottlenecks that constituted constraints militating against he smooth running of the NHIS.

Source: Daily Graphic

Leave A Reply

Your email address will not be published.

Shares