The National Health Insurance Authority (NHIA) has directed the Akim Oda Government Hospital to reimburse GHC312,413.15 to the Authority following an audit initiated by its CEO, Dr. Victor Bampoe.
The audit was prompted by a whistleblower report alleging fraudulent practices at the facility.
Dr. Bampoe commissioned the investigation in accordance with Sections 31(1) and 35(2) of the National Health Insurance Act (Act 852) 2012.
From July 14 to 18, 2025, a multidisciplinary audit team, including personnel from the NHIA’s Quality Assurance and Internal Audit directorates, the Claims Processing Center (CPC) in Accra, and an external clinician, was tasked with validating the hospital’s claims and assessing the services provided to National Health Insurance Scheme (NHIS) members.
Key Findings and Recommendations
The NHIA audit identified several irregularities in the hospital’s submitted claims. These included discrepancies between medicines billed and those actually dispensed, overbilling of certain drugs, and inappropriate prescribing of antibiotics, opioids, and anticoagulants.
The audit also found that the hospital had applied incorrect catering-inclusive tariffs and demanded out-of-pocket payments from NHIS members for services that should have been covered by the scheme.
The NHIA has therefore recommended a refund of GH₵312,413.51 and called for stricter validation of future claims.
The report stated, “The Authority will not tolerate breaches that undermine public confidence in the National Health Insurance Scheme (NHIS).”
“The facility is hereby directed to refund GH¢312, 413.51 to the NHIA for various breaches and irregularities identified in claims submitted,” the sanctioned report also noted.
The audit revealed that the hospital, credentialed as a Public Primary Hospital with a catering exclusive designation, incorrectly applied catering-inclusive tariffs throughout the review period, which contributed to inflated claims.
Additional Discrepancies
The report further recommended, “The facility must desist from asking active NHIS members to make out-of-pocket payments for services covered by the Scheme.” It also stated that “Subsequent claims, starting from May 2025, should be thoroughly validated before reimbursement.”
Credentialed as a Public Primary Hospital (Catering Exclusive) with a 162-bed capacity, the facility submitted 120,589 claims between January 2024 and April 2025, amounting to GH¢47,645,535.00.
The audit, however, uncovered multiple discrepancies, including:
- Medicines billed to the Scheme but not dispensed.
- Overbilling of pharmaceuticals.
- Inappropriate prescribing of antibiotics, opioids, and anticoagulants.
“There were variances in the quantities of medicines dispensed in the facility’s system and those submitted to NHIA for reimbursement,” the report found.
It also noted that “members of the scheme make out-of pocket payments for some services and medicines covered by the scheme,” which is a direct violation of NHIS policy.
The report concluded, “The audit identified non-compliance with regulations and directives. Appropriate recommendations have been made to improve the NHIS and to ensure the financial sustainability of the Scheme.”
By: Rainbowradioonline.com/Ghana