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NHIS retrieves GH¢8m from service providers

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Health InsuranceAbout GH¢8 million out of GH¢22 million fraudulently paid to service providers of the National Health Insurance Scheme (NHIS) since 2005 has been retrieved.

Some individuals found to have been involved in the payments are facing trial at the courts, with one person already convicted.

The Deputy Chief Executive of the National Health Insurance Authority (NHIA), Mr Nathaniel Otoo, stated this when he appeared before the Public Accounts Committee (PAC) of Parliament in Accra yesterday.

Mr Otoo was invited by the committee to answer questions bordering on the management of claims by the NHIA, an issue which is contained in the performance audit report of the Auditor-General.

The PAC had sought to know from Mr Otoo the measures that had been put in place to ensure that money paid to people who were undeserving of the payments was returned into the NHIA’s coffers.

Officials of the Ministry of Health (MoH), the Ghana Aids Commission (GAC), the Ghana Revenue Authority (GRA), the Ghana Supply Company (GSC) Limited and Danadams Pharmaceutical Industries Ltd also appeared before the PAC to educate it on how anti-retroviral drugs (ARVs) are distributed in the country.

Mr Otoo, who is in charge of Operations at the NHIA, said the authority was in the process of recovering GH¢10 million, which represents “over-payments” to clients, from service providers.

The remainder of the amount, he said, was in dispute.

“This is money that should not have gone out but went out,” he said.

He stated that the NHIA realised that the GH¢22 million had been wrongly paid to the service providers after conducting “clinical” audits into its financial operations and added that measures had been put in place to ensure that those over-payments to clients did not occur again.

Mr Otoo said some of the payments were fraudulently done, while others were found to have been done as a result of technical infractions.

Since 2005, the licences of about 100 service providers have been withdrawn as a result of proof of fraud.

According to him, the audits revealed that some service providers submitted bills higher than required, while some individuals not qualified to prescribe drugs for patients did so in a bid to defraud the NHIA.

He said the absence of serial numbers on prescription forms in Ghana made their use for fraudulent activities easy, pointing out that the forms needed to be serialised, “so that they become pseudo-valid documents and help us check fraud”.

On the capitation system introduced in the Ashanti Region a year ago, Mr Otoo said the programme had been successful and added that in September a meeting would be held to decide on when to introduce it to other parts of the country.

During the interaction between the committee and officials of the MoH, the GAC, the GRA, the GSC and Danadams, it came to light that 20 out of the 24 HIV treatment sites submitted inaccurate data to the National Aids Control Programme (NACP), a situation which made it impossible for the NACP to procure the right quantity of ARVs for persons living with HIV (PLHIVs).

It was also revealed that drugs purchased in 2008 and 2009, amounting to GH¢323,009, had not been delivered.

What was worse, drugs purchased arrived in bits or small consignments or quantities and were not cleared from the Kotoka International Airport in time.

The committee also found that moneys collected from PLHIVs (GHc5 per person) were not properly accounted for.

In Yendi, for example, a nurse was reported to have lodged the moneys in his private bank account, while at the Sandema and the KNUST hospitals GH¢2,075 collected was kept in the offices.

The committee took a serious view of the developments and urged the NACP to ensure that HIV treatment sites submitted the right data for the required quantities of ARVs to be purchased.

With regard to the delay in clearing the ARVs from the airport, it recommended that the Procurement Unit of the MoH must ensure that the airway bills were written in the name of the MoH and provide the necessary documents to the GSC on time to facilitate the clearing.

It also urged the NACP to retrieve all moneys collected by individual staff members and those invested in private accounts with accrued interest and sanction staff members who were found to have violated directives from the Director-General of the Ghana Health Service to lodge funds in the hospital account.

Source: Daily Graphic

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