National Health Insurance Authority recovers GH¢16m from false claims
The National Health Insurance Authority (NHIA) has recovered GH¢16 million in respect of false claims made in the National Health Insurance Scheme (NHIS) in the Ashanti Region.
A clinical audit of the scheme in the region, which exposed the false claims and ensured the subsequent recovery of the amount by the NHIA, also revealed serious financial leakage, especially malfeasance resulting from systemic fraud and abuse.
The audit, which was ordered by the NHIA in the face of rising cost of claims, was to analyse the relationship among diagnosis, treatment and claims paid to service providers.
The Chief Executive Officer (CEO) of the NHIA, Mr Sylvester Mensah, made this known at a meeting with members of the Provider Payment Systems Technical Sub-Committee on Capitation and members of the Ashanti Regional Implementation Committee in Kumasi, during which Members of Parliament (MPs) were briefed on preparations for the launch of the pilot capitation programme.
The capitation programme is a health care reimbursement model in which the provider is paid a fixed amount per person, regardless of the number or type of services the person requires.
The capitation, which is being piloted in the Ashanti Region, is expected to create a healthcare marketplace where subscribers choose their providers and generate provider competition in terms of improving infrastructure, equipment, the relationship between medical personnel and patients and ultimately promote quality of care.
The purpose of the pilot is to learn lessons and eventually roll out capitation across the country as an additional provider payment mechanism.
Mr Mensah said to stem the tide of fraud in the prescription of medicines, the NHIA, in collaboration with the Ministry of Health, had developed a new prescription form with a unique identifier of provider and prescriber that would come into use before the end of 2011.
On measures to check irregularities in premium collection, he said the NHIA had set up a consolidated premium account into which all premiums collected by the schemes were now deposited.
The measure, he noted, had improved accountability, adding that new strategies, particularly electronic collection, were being considered to seal other loopholes in premium collection.
Mr Mensah observed that the current provider payment system placed the entire risk burden on the scheme, adding that the capitation would address the imbalance and introduce risk-sharing among providers, subscribers and the scheme.
The MPs, for their part, pledged to fully support the public education of their constituents in the Ashanti Region, some of whom were uninformed or had been misinformed on the capitation and, therefore, had misconceptions or were apprehensive about its implementation.
The MP for Old Tafo, Dr Anthony Akoto Osei, noted that the NHIS was a very important social intervention that must be sustained and called on all stakeholders to work together to make the capitation a success.
The MP for Offinso North, Mr Augustine Collins Ntim, also described the capitation pilot as a laudable project but expressed concern over the delays and interruptions to the flow of funds from the Ministry of Finance to the NHIA.
Source: Daily Graphic