GH¢92,000 NHIS fraud uncovered

At a time when the National Health Insurance Scheme (NHIS) is reeling under heavy financial burdens that threaten the very survival of the scheme, some Service providers have devised ways of milking it dry of the little resources left.

A clinical Audit conducted by the National Health Insurance Authority (NHIA) at the Dunkwa Government Hospital has revealed multiple instances of questionable claims made by the facility for the period between 2014 and 2016.

The audit, which was undertaken on the instance of preliminary investigations conducted by The Finder, found that the facility, which is a service provider made wrongful claims to the tune GH¢92,000 within the period under review but sources close to the facility say this amount could just be a fraction of the colossal amount the NHIS might have lost to the shady deals in that facility.

Initial information gathered by The Finder indicated that, the facility was making claims for medicines with higher values but which were not given to the patients or making patients look sicker than they were and made and dispensed medications that were, in actual fact, not necessary.

Information gathered by The Finder indicates that the only time the hospital procured for example,  DIHYDROARTIMISISININ PIPERAQUINE popularly called P-ALAXIN was somewhere in  2012 but the drug was still used to make claims from the Scheme even in 2015 because of its high tariff.

 

P-ALAXIN has a tariff of GHC6.45, which is higher than most of the class of other drugs in the treatment of common illness.

The Finder also learnt that even though the drug which was used by the facility in 2015 were ATEMETER LUMEFANTRINE and ATESUNATE AMODIAQUINE which had tariffs of GHC3.90 and GHC3.70 respectively, P-ALAXIN was a common drug .

The Finder then furnished the NHIA with documents, leading to an audit which confirmed the earlier finding.

The Quality Assurance Unit of the NHIA, which conducted the audit, told The Finder that their audit found that some drugs on the claim form were, indeed, not given to the patients. Additionally, the unit recorded multiple instances of wrong application of tariffs which means that claims were made with drugs with higher tariffs than was actually administered.

The audit also found other instances of inadequate information on the claim forms.

The Hospital is said to have written to contest the audit findings. 

Surprisingly, officials at the NHIA are unwilling to make available the audit report to The Finder when a request was made for it.

Sources at the Dunkwa Hospital say, the individuals, who were found culpable of the defrauding the Scheme, has very strong political ties which make them untouchable.

“At first, we thought all these were done at the blind side of the authorities of the hospital, but later we were convinced it was a well-orchestrated scheme to make money and share among themselves”, a source at  the hospital told The Finder. 

Officials at the NHIS say they have no intension prosecuting the fraudsters because “they have not given them the reason to do so” 

Alternatively, the NHIS is considering deducting the amount detected to be fraudulent claims from its payments to the hospital.

The Public Relations officer for the NHIA told The Finder that “fraudulent claims made by service providers are issues the Authority deal with on regular basis”.