In a bid to ease the wheels of justice, the National Health Insurance Authority (NHIA) has begun processes to enable it prosecute cases of fraud against the scheme says Dr Lydia Baaba Dsane-Selby, Deputy Chief Executive, Operations.
This move has become necessary due to the overwhelming number of cases at the AG’s department, including those on healthcare fraud.
Reports have it that, some cases of fraud by individuals against the scheme are still pending in court for more than seven years.
Addressing the issue of fraud in the health sector, Dr Dsane-Selby opined that, “there isn’t enough understanding of the health insurance fraud in the country or health insurance fraud generally.”
Healthcare fraud and abuse are major concerns facing many healthcare systems particularly health insurance organisations in Sub-Saharan Africa.
Health care fraud includes health insurance fraud, drug fraud, and medical fraud.
It is estimated that fraud and abuse cost up to 10 percent of total healthcare expenditure in countries worldwide.
Research report on Ghana by BMC Health Services in 2017 shows that, in 2014, 29.64 million outpatient utilization claims and 1.62 million inpatient utilization claims were reviewed, and a total amount of GHS 968.48 million (USD254.19 million) was paid.
This payment contributed about 80 percent of healthcare providers’ internally generated fund.
Dsane-Selby said “there is very little appetite to go after fraudsters within the health sector, if we are really honest.”
For this reason, Dsane-Selby explained that the Authority’s legal department, upon request, have been given prosecutorial powers by the Attorney-General to swiftly deal in its own cases.
“So going forward, this back and forth to find solutions to our cases may be a thing of the past,” she said.
Dsane-Selby added that the AG’s department is training the Authority’s lawyers up to where they would make a difference.
After undergoing this training, the Authority anticipates that the huge costs encountered in prosecuting cases in court will reduce.
In a related situation, about 42 officials of the authority are under investigation by the internal audit division for various acts of corruption and misappropriation of funds.
At a day’s stakeholders’ engagement in Tamale, last month, the Chief Executive Officer of the Authority, Dr. Samuel Annor disclosed that the agency is in the process of meting out some punitive disciplinary actions against accused staff members.
Staffs whose acts or omissions bother on criminality like fraud are to be prosecuted in the law courts.
By Joshua W. Amlanu