The National Health Insurance Authority (NHIA) has directed the Akim Oda Government Hospital in the Eastern Region to refund GHC 312,413.51 due to operational malpractices and irregularities in claims submissions. The decision follows a Clinical and Compliance Audit conducted from July 14 to 18, 2025, which uncovered widespread discrepancies in the hospital’s claims.
Key Findings of the Audit
– Discrepancies in Medicine Dispensing and Billing: The audit revealed variances in the quantities of medicines dispensed and those billed to the NHIA for reimbursement.
– Overbilling of Pharmaceuticals: The hospital was found to have overbilled the NHIA for certain drugs, contributing to inflated claims.
– Inappropriate Prescribing Practices: The audit identified inappropriate prescribing of antibiotics, opioids, and anticoagulants, which further inflated claims.
– Wrong Application of Catering-Inclusive Tariffs: Despite being credentialed as a catering-exclusive primary hospital, the facility applied catering-inclusive tariffs, resulting in additional irregularities.
NHIA’s Directives
In light of these findings, the NHIA has ordered the hospital to:
– Refund GHC 312,413.51 to the Authority for the breaches and irregularities identified.
– Stop Demanding Out-of-Pocket Payments from NHIS members for services already covered by the Scheme.
– Ensure Strict Validation of all future claims before reimbursement, starting from May 2025.
NHIA’s Commitment to Accountability
The NHIA’s Chief Executive, Dr. Victor Asare Bampoe, emphasized the Authority’s commitment to safeguarding the financial sustainability of the Scheme and ensuring that public funds are used appropriately. He pledged to intensify nationwide audits to curb fraudulent claims and eliminate illegal co-payments, aligning with the vision to achieve Universal Health Coverage.