The National Health Insurance Authority (NHIA) has stripped two health centres of their accreditations to operate on the National Health Insurance Scheme (NHIS) for forging financial claims presented to the authority.
The Chief Executive Officer of the NHIA, Dr Lydia Baaba Dsane-Selby, said investigations were still ongoing to determine further actions to discourage the practice.
“Health insurance fraud is a big business across the world. But we want to check it hard and discourage administrators of health centres, owners, etc, from such practice,” Dr Dsane-Selby told the Daily Graphic.
Facilities
The two facilities, which she declined to name for now, were said to have been exposed by subscribers in whose names those facilities had made claims for reimbursement from the NHIA.
She credited the discovery of the alleged fraud to the efficiency of the self-renewal subscription system introduced by the authority and launched by the President exactly a year ago.
The self-renewal process, activated by the *929# short code, enables the NHIS to prompt a subscriber to confirm whether they have used a health facility making claims in their name.
In the case of the suspended two facilities, Dr Dsane-Selby said two subscribers denied ever visiting those facilities for two years.
She said it triggered investigations which confirmed the statements of the two whose responses were independent of each other.
The scheme currently has 22 million people on its database, with 12.1 million active subscribers, and Dr Dsane-Selby said between 70 and 80 per cent of the scheme’s active membership had renewed their annual subscriptions via the mobile phone short code process.
Satisfaction
While expressing overall satisfaction with the public’s acceptance and usage of the self-renewal process, she said the Greater Accra Region had the highest number of physical visits to the NHIA offices for subscription renewal purposes.
She said as of now, up to 150,000 people accessed health services on the scheme from the 4,500 registered facilities across the country, stressing that “the NHIS is very vibrant”.
“On the whole, 42 per cent of the country’s population are active members of the scheme, with the Greater Accra Region’s 1.7 million active subscribers being the lowest in relation with population size”, the NHIA Chief Executive added.
She said with pregnancy cases, breast cancer and children under five years among the most critical cases covered by the scheme, universal health coverage in the country was achievable in the not-too-distant future.
She said the authority was working to put prostate cancer and family planning on the scheme.