National Health Insurance Authority interdicts 32 officers for indulging in fraudulent activities

Posted: May 25, 2010 in Crime, Health
Tags: , ,

The National Health Insurance Authority (NHIA), administrator of the National Health Insurance Scheme (NHIS) has interdicted thirty-two (32) of its scheme officers nationwide, for indulging in fraudulent activities and misappropriating funds belonging to the Scheme.

Sylvester Mensah, CEO of National Health Insurance Authority

While some are on summarily dismissal, others are on suspension for a specific period with four (4) currently in Police custody pending further investigations.

“The Authority will not hesitate in dealing with any abuse of fraud emanating from the Scheme. The Scheme is bleeding and you and I have a responsibility to stop the hemorrhage,” warns Mr. Sylvester Mensah, Chief Executive Officer (CEO) of the NHIA at a training program on financial reporting for officers of the Scheme in the Greater Accra Region yesterday.

Among the beneficiaries of the training program include; Managers of Information Systems, Scheme Assistants, Claims managers, Scheme managers as well as Monitoring and Evaluation officers.

Some of the interdicted officers include the Scheme and Claims managers of Ketu, Emmanuel Avernyo, Scheme manager for Ketu and Charles Awusi as well as the accountant John Hadzi.

In Sekeyere West, the Scheme manager, claims officer and Accountant of the Scheme, according the NHIA boss have summarily been dismissed together with some officers from the Akuapim South.

Also to incur the wrath of the NHIA is the Scheme officer in Nanumba Nort. He has also been dismissed for engaging in fraudulent activities. The Scheme managers for Ada and Okaikoi in the Greater Accra Regio, Mr. Mensah noted, are on suspension for one month, effective May 30th 2010.

“These are very serious offenses for which further action will be taken,” bemoaned Mr. Mensah.

Concerned over the numerous abuses confronting the Scheme, Mr. Mensah said his outfit is embarking on a number of cost containment strategies to curb the anomaly.

In effect, he said a consolidated premium accounts have been set up with the Agricultural Development Bank (ADB) and the Ghana Commercial Bank (GCB),to enable Scheme managers deposit all premiums collected, effective July 31st 2010.

“The practices where premiums are not accounted for, where funds over 50% premiums collected cannot be traced, where collecting agents go round, register people and the scheme is unable to identify the people who collected the funds, should be a thing of the past,” noted Mr. Mensa.

He added “we will be watching on the issue of contract registration agents subsequently. These will serve as basis for determining whether the schemes are functioning. If you are not registering, you are not depositing funds into the accounts; the implication is that you are not working.”

Another strategy developed by the Authority is the set up of a Consolidated Scheme Management Centre at Dworwulu. This centre, according to Mr. Mensah, will authorize all Schemes effective July 1st 2010 to forward their bills to the centre instead of the normal practice of forwarding their bills to a Teaching Hospital.

“The scheme has experienced quite a number of abuses with regards to the administration of the Schemes. We have on record that claims from the regional and teaching hospitals account for almost 40% of the budget of the NHIA. If we are able to put together enough capacity to operate as a claim centre, we would have reduced cost and injected greater efficiency in the claims of premiums from the regional and teaching hospitals,” he noted.

He said the Authority will be issuing new prescription forms to all its accredited service providers nationwide as part of measures to address the numerous challenges confronting the Scheme.

“These NHIA prescription forms would have or had the personal identification card of the subscriber, and also the identification number of the provider. With this, we will be tracing the prescriber when there are difficulties with prescription. These will help address the difficulties that we are encountering, the leakages, the fraud with the use of the current prescription forms,” he added.

Mr. Mensah noted that in-spite of the aforementioned measures which are yet to be implemented, the Authority in its routine clinical audit from January-March this has been able to recover an amount of GH¢5.2 million as excess payment to providers with the Northern Region recording GH¢1.1 million. He believes that with the implementation of the new measures, a lot could be saved to enable the Authority perform its operations efficiently.

Another major reform to streamline the activities of the Scheme, Mr. Mensah noted is the introduction of capitation to care for out patients. According to him, this will be done on pilot basis, beginning from the Ashanti Region effective July this year.

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