Plans are underway by the National Health Insurance Authority to set up a dedicated Anti-Fraud and Illegal Payments Directorate in a major push to eliminate unauthorised out-of-pocket fees levied by healthcare providers.
The upcoming directorate aims to bolster the Authority’s regulatory muscle in spotting fraudulent activities, tracking down illegal billing, and plugging claims leakages that threaten the longevity and efficiency of the National Health Insurance Scheme.
Alongside this administrative step, the NHIA is pressing Parliament to fast-track amendments to the National Health Insurance Authority Act, 2012 (Act 852). The proposed legislative changes seek to toughen penalties for persons and health facilities found culpable of fraud and illicit charging.
Dr Kwesi Djokoto, the Deputy Chief Executive Officer in charge of Operations at the NHIA, made the appeal when members of Parliament’s Health Committee paid a working visit to the Authority.
Addressing the legislators, Dr Djokoto stressed that robust laws are vital to back the NHIA’s current digital overhaul and operational streamlining, which are designed to speed up claims management and tighten oversight of service providers.
He pointed out that while the Authority has poured resources into modern technological systems, legislative backing remains crucial for strict enforcement.
“We have super digital infrastructure in place that would support our operations, so the committee can help us prioritise the amendment of Act 852. The Ministry of Health is already working on it. It is strengthening sanctions for fraud and illegal payments and supporting capital budget funding for the year 2027.
“In summary, claims are electronic, with a 20-day turnaround time; we are paying monthly, and we have digital interventions to enhance the work of the National Health Insurance Authority.”
The stance taken by Dr Djokoto highlights the belief within the NHIA that cutting-edge technology must go hand in hand with a potent legal framework to keep malpractice at bay and guarantee strict adherence to scheme regulations.
By: Rainbowradioonline.com/Ghana