NHIA annuls over GH¢1.1m clinical and compliance audit adjustment imposed on La Polyclinic
Management of the National Health Insurance Authority (NHIA) has annulled the recommended clinical and compliance audit adjustment of GH¢1, 199,841.02 imposed on the La Polyclinic.
The National Health Insurance Authority (NHIA) has stated its readiness to refund to La Polyclinic an amount of GH¢288, 809.14 earlier deducted from the claims submitted.
The decision of the NHIA followed an appeal by the management of La Polyclinic of non-reimbursement of NHIS claims to the facility as a result of procedural issues with the then La General Hospital.
Addressing the media, the Chief Executive Officer (CEO) of the National Health Insurance Authority (NHIA), Dr Bernard Okoe Boye has urged the management of the La Polyclinic to take immediate steps to initiate the credentialing of the La Polyclinic as a separate entity from the defunct La General Hospital.
“…take immediate steps to initiate the credentialing of La Polyclinic as a separate entity from the defunct La General Hospital. This is a rare privilege granted to La Polyclinic considering the peculiar circumstances stated in your letter, and the cordial working relationship between the NHIA and Ghana Health Service”, he stated.
Dr. Okoe Boye, however, expected that the refund and the eventual annulment of the clinical and compliance audit adjustment imposed on La Polyclinic would help catapult the facility to expand its services and deliver quality healthcare to NHIS members.
Madam Joyce Dassah, Administrator, La Polyclinic, giving the background leading to the challenge of the facility, said that the clinical audit conducted in 2015 by the NHIA at the then La General Hospital which some undeserving payments were made to the hospital affected the operations of the La Polyclinic when the redevelopment of the hospital began in 2020.
Madam Dassah explained that the services of the La General Hospital have scaled down to a polyclinic but due to the procedural issues detected as a result of the unearned monies paid to the then La General Hospital, the La Polyclinic since 2020 has had some challenges with the NHIS reimbursement.
“…some clinical audit was conducted somewhere in 2015 at the then La General Hospital where they observed some payments were made which was not deserving for the General Hospital.
The NHIA in that respect had to reclaim those unearned monies. That is why we realise the facility has been suffering for some time now, we don’t have money and we refer everything to the NHIS.
Some follow-ups were made to the NHIA and they also went through their documents and realised that we need to make some correspondences through our office to the Director-General of the Ghana Health Service. The Director-General also followed up with our request to the NHIA to check the system for the anomaly,” she explained.
Mr Bernard Brown, Director of Operations Coastal Belt, therefore, instructed the management of the La Polyclinic to regularise the operations of the polyclinic by going for a separate credentialing different from the erstwhile La General Hospital.
“Put the necessary things in place to have your separate credentialing as soon as possible. We are happy about this news of annulment and refund to La Polyclinic. We are also happy to see that some primary healthcare is being provided for the people of La and its environs”, he said.
Source: GNA