2 Hospitals Suspended-for indulging in fraudulent activities (Front Page)

THE National Health Insurance Authority (NHIA) has suspended Atasomanso and County hospitals, two private hospitals in the Kumasi metropolis, for allegedly indulging in fraudulent activities including double billing, over-billing and irrational prescriptions.
The action of the authority is based on the results of investigations carried out by its clinical audit team between March 23 and March 27, 2009.
The two hospitals have appealed against the NHIA’s decision but a review by healthcare professionals upheld the findings and decision of the NHIA.
The NHIA has further directed that the Scheme Manager and the Accountant at the Ga District Mutual Health Insurance Scheme (DMHISs) at Amasaman in the Greater Accra Region, should step aside for thorough investigations into the operations of the scheme.
Briefing the media in Accra yesterday, the acting Chief Executive Officer (CEO) of the NHIA, Mr Sylvester Mensah, said the suspension of the two health facilities, covering a three-month period, would be effective from August 14 to November 13, 2009.
By the suspension, Mr Mensah advised subscribers to desist from visiting the two facilities for medical care, “as cases attended to during the period of the suspension will not be reimbursed by the schemes”.
Throwing more light on the issue, the acting CEO said while the two hospitals in Kumasi allegedly indulged in illegalities which included double billing, over-billing and non-adherence to tariffs, irrational prescription, poor quality care and unsupported claims, as well as fraud, the suspended NHIS officials were involved in alleged fraudulent deals which together cost the scheme huge sums of money.
“Clearly the activities of these two hospitals constitute serious financial leakages of the scheme that must be stopped. It is worth noting that the two hospitals appealed against the decision and the NHIA’s findings were subjected to a review by healthcare professionals drawn from the private and public sector. The review upheld the NHIA findings,” he pointed out.
The sanction, according to Mr Mensah, was provided by the National Health Insurance Act 650 of 2003, which mandated the authority to secure the sustainability of the National Health Insurance Scheme (NHIS) through prudent financial administration at all levels.
He further explained that financial claims and audits done on the Ga DMHISs covering the period January 1, 2007 to December 31, 2007 revealed anomalies ranging from misapplication of funds, inability of the scheme to account for monies, poor control/conflict of interest and weaknesses in organisational processes, as well as outright incompetence on the part of the management of the scheme.
He hinted that the NHIA would deploy all means at its disposal to ensure that perpetrators of acts which sought to undermine the sustainability and integrity of the NHIS or compromise the quality of care offered NHIS members, were brought to book.
He pointed out that the audits that the authority had conducted and continued to conduct were not witch-hunting but an effort to ensure that the resources and safety of the public were protected and asked for support from the media in that direction.
Mr Mensah said the NHIA did not take for granted the enormity of the task facing the authority alone but the nation at large to ensure that “we protect this key national effort at improving access to health care for all residents of this country”.
Meanwhile, he said work on the introduction of the one-time premium payment for health insurance was far advanced, adding that it was the expectation of the authority that the government’s promise in that regard was fulfilled.
He also announced that the Minister of Health, Dr George Sipa-Adjah Yankey, had ordered a forensic audit into the operations of all the 145 District Mutual Health Schemes (DMHISs) in the country beginning from next week.
That is because an initial internal auditing conducted by the NHIA in some schemes in the Greater Accra and the Ashanti regions has revealed anomalies in their operations.