The National Health Insurance Authority (NHIA) has directed the Akim Oda Government Hospital in the Eastern Region to refund GH¢312,413.51 following the discovery of fraudulent claims submitted to the Scheme.
The directive follows a Clinical and Compliance Audit commissioned by NHIA Chief Executive, Dr. Victor Asare Bampoe, in response to a whistleblower report alleging malpractice at the facility between February and May 2025. The audit was carried out from July 14 to 18, 2025, by a multidisciplinary team drawn from the NHIA’s Quality Assurance and Internal Audit directorates, the Claims Processing Centre in Accra, and an external clinician.
Key Findings
The investigation uncovered widespread irregularities, including:
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Discrepancies between medicines dispensed and those billed.
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Overbilling of pharmaceuticals.
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Inappropriate prescribing of antibiotics, opioids, and anticoagulants.
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Wrong application of catering-inclusive tariffs despite the hospital’s designation as a Catering-Exclusive Public Primary Hospital.
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Out-of-pocket charges demanded from NHIS members for services already covered by the Scheme.
The report concluded that these breaches inflated the hospital’s claims and undermined trust in the NHIS.
NHIA’s Directives
In its ruling, the NHIA ordered the facility to:
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Refund GH¢312,413.51 to the Authority.
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Stop demanding out-of-pocket payments from NHIS members for covered services.
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Ensure all future claims, beginning May 2025, undergo strict validation before reimbursement.
The audit revealed that between January 2024 and April 2025, the hospital submitted 120,589 claims amounting to GH¢47.6 million. Significant inconsistencies were detected, including medicines billed but not dispensed and inflated pharmaceutical costs.
Safeguarding the Scheme
The Authority stressed that such practices will not be tolerated, warning that they compromise public confidence in the Scheme.
“The facility is hereby directed to refund GH¢312,413.51 for the breaches and irregularities identified,” the report stated.
Dr. Bampoe, since assuming office, has championed stronger financial controls and accountability in the administration of the NHIS. He has pledged to intensify nationwide audits to curb fraudulent claims, eliminate illegal co-payments, and safeguard the financial sustainability of the Scheme.
He further emphasized that government remains committed to timely release of funds for claims payments, noting that the Scheme is currently debt-free due to consistent financing and the uncapping of the National Health Insurance Levy (NHIL).
“Funds must always be used for their intended purpose. Co-payments and fraudulent claims must be eliminated at all costs,” Dr. Bampoe stressed, adding that the reforms align with President Mahama’s vision to achieve Universal Health Coverage by removing financial barriers to healthcare.
Story By: Afia Ohenewaa Akyerem