NHIA discovers more fraud (Sat. October 10, 2009)

A SPECIAL audit conducted by the National Health Insurance Authority (NHIA) in the Ashanti Region has revealed illegalities on the part of officials in 11 district schemes under the National Health Insurance Scheme (NHIS).
The authority has, therefore, asked the Serious Fraud Office (SFO) in Kumasi to conduct further investigations into the matter.
In addition, the NHIA has also directed the affected officers who are mainly scheme managers, accountants and claims managers to refund various sums of monies which they were alleged to have either misappropriated or embezzled. Some of the officers have been interdicted while others were asked to step aside depending on the level of the allegation.
The district schemes involved are Asokwa, Sekyere West and East, Atwima Nwabiagya, Ashanti Akyem North and South, Offinso, Ejisu Juaben, Manhyia, Afigya Sekyere West and Subin.
At a press briefing in Accra yesterday, the acting Chief Executive Officer (CEO) of the NHIA, Mr Sylvester Mensah, said the exercise, which had began in the Ashanti Region, would be carried to the rest of the country.
Giving the breakdown as to the specific amount involved, Mr Mensah said at the Asokwa sub-metro scheme, the audit team realised that GH¢569,104.02 of monies meant for the payment of claims could not be accounted for.
In the Sekyere East District, he said the accountant, who failed to account for GH¢66,121.00 of premium and processing fees, admitted the offence and had refunded GH¢10,000. In addition, the CEO said the district misapplied a total of GH¢800,000 meant for claims and other purposes.
Mr Mensah said the Atwima Nwabiagya District scheme officers overpaid service providers a total of GH¢7,544.30; Ashanti Akyem North misappropriated GH¢7,650 and in addition transferred GH¢25,906 claims monies for administrative purposes.
In the Ashanti Akyem South, he said the scheme could not account for GH¢3,393 of premium collected and also transferred GH¢44,320 for administrative purposes. The Offinsoman scheme allegedly conducted business with unaccredited service providers and without submitting claims to the NHIA, went ahead to reimburse those providers.
Mr Mensah said Ejisu Juaben District scheme officials failed to account for GH¢5,145 of premium collected and also the Manhyia scheme used funds meant for payment of claims to acquire an office building at a cost of GH¢148,000.
The CEO stated that Afigya Sekyere scheme misapplied GH¢133,35.87 meant for claims for administrative expenses; Subin spent GH¢GH¢23,702 on preliminary expenses towards acquisition of a land which had not as yet been acquired.
Mr Mensah added that spot checks conducted into the activities of some service providers brought up unpleasant findings which called for further investigations, adding that clinical audit would be conducted at Oforikrom Hospital, as well as Nimo Pharmacy in Kumasi; Akoma Hospital in Ashanti Bekwai; Asonomaso Hospital and Joy Maternity Home at Offinso.
Others are First Class Hospital at Konongo; Neighbourhood Hospital at Obuasi; Fomena Hospital and Fred Hospital at Akrofrom.
He explained that issues involving some of the service providers would be referred to the various professional and regulatory bodies while the more serious ones which involved fraud would be sent to the security agencies for investigations and if possible prosecution.
In August this year, NHIA 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 was based on the results of investigations carried out by its clinical audit team between March 23 and March 27, 2009.
The two hospitals appealed against the NHIA’s decision but a review by healthcare professionals upheld the findings and decision of the NHIA.