Highly punitive measures await defrauders of NHIS - Dr Annor

The National Health Insurance Authority (NHIA) has put in place stringent measures to crack down on all service providers and its staff who connive to defraud the authority of its limited resources.

In view of that, the Chief Executive Officer of the NHIA, Dr Samuel Yaw Annor, has warned all those who have been dealing with the authority to be wary and refrain from abusing the funds of the scheme, as the authority has put in place highly punitive measures against any abuse.

In an interview in Accra, Dr Annor said the new measures of the authority would make defrauders pay not less than 10 times the amount they stole from the scheme and when convicted, they would also go to prison for a minimum of two years.

Recent ruling/two jailed

Citing the recent court ruling in which a former medical superintendent of the Esikado District Hospital, Dr N K Ametewee, and one Francis Ametewee were jailed 15 years for defrauding the NHIS to the tune of GH¢415,000, Dr Annor said the authority was currently liaising with the Attorney-General to give it prosecutorial powers to fast-track the prosecution of all persons who abused the scheme.

Dr Ametewee was last Thursday jailed 10 years by the Sekondi High Court for defrauding the National Health Insurance Authority (NHIA) to the tune of GH¢415, 000.

He was convicted and sentenced together with his accomplice and brother, Francis Ametewee, who served at the records department of Dr Ametewee’s private dental clinic at Anaji in Takoradi. Francis was given a five-year jail sentence.

Dr Ametewee and his accomplice duplicated claims submitted by the Dental Unit of the Essikado District Hospital and resubmitted same for his private clinic at West Anaji Dental Clinic for payment.

In a calculated attempt, they systematically submitted the same names to the NHIA for payment to both the District Hospital and the private clinic.
Enquiries, however, made by the NHIA audit team revealed that none of the names Dr Ametewee submitted for claims as National Health Insurance Scheme (NHIS) card holders ever patronised his clinic for any ailment or condition.

Strengthening legal department

According to Dr Annor, the NHIA was also training and strengthening its legal department to enable it to swiftly handle such matters internally instead of overburdening the Attorney General’s Office.

He said the authority was embarking on more clinical audits across the country and any “provider who is found culpable will not be spared.”

Stringent measures

As part of the stringent measures, Dr Annor said the management of the NHIA was re-structuring the NHIS on four pillars, including fully implementing electronic claims management to improve efficiency and reduce fraud.

He said the authority was also working to improve compliance (Clinical & Internal Audits) to mitigate fraud and amend the NHIS law to make crime against the scheme more punitive and a deterrent to potential fraudsters.

Finally, he said the authority was re-designing the financial model to increase premiums and/or processing fees: health tax on sugar, alcohol & tobacco, increase National Health Insurance Levy (NHIL) from 2.5 per cent to 3.5 per cent, one per cent deduction of employee salary to be matched by two per cent from employer and one per cent of the Ghana Infrastructure Fund (GIF) into the National Health Insurance Fund (NHIF) and 20 per cent of communication tax issued.

Mobile membership renewal

Dr Annor said the NHIA had introduced an innovative NHIS mobile membership renewal for all members to be used to check the status of NHIS membership eligibility, NHIS benefit package and NHIS medicines list.

Currently, the NHIA is also testing the option to allow members to complete their annual membership renewals comfortably and safely from their mobile phones to reduce waiting time.

The NHIS mobile membership renewal service, which will be formally launched soon and rolled out in phases, is currently being piloted in Asuogyaman and West Manprusi districts.