Former NHIA CEO Sylvester Mensah Assists BNI In Investigations

A former CEO of the NHIA has been invited by the BNI to assist them in their investigations. 

Five officials of the National Health Insurance Authority (NHIA) have been arrested by the Bureau of National Investigations (BNI) following investigations into suspected acts of fraud in the payment of claims to medical facilities.

The investigations, which began six months ago at the instance of the President, John Dramani Mahama, has led to the interrogation of 48 people from the NHIA and the suspected medical facilities.

17 persons from various district and regional offices have been cautioned and granted bail. Two others from the head office are on bail, while another three are currently before court.

BNI sources say, many of the medical facilities have been falsifying documents and submitting bloated claims to the NHIA, and in some cases colluded with officials of the NHIA to defraud the Authority. 

Some officials have also been found to be engaging in the inclusion of non-NHIA registered medical facilities for private gain.
 
There have been intensified interactions between the NHIA and BNI within the past few weeks, with various NHIA directors and managers briefing the BNI on their roles, targets and work processes.

Some healthcare providers too have been visited and their books looked at in respect of how claims from the provider end are processed before they are submitted to the NHIA for vetting.

Some of the areas of interest to them have been…

1. The Accreditation/credentialing process: What processes a health facility goes through to become a service provider of the NHIA.

2. Provider tariffs: How tariffs for providers are calculated and what tariffs apply to the various provider levels under the NHIS.

3. Claims: How claims are vetted/processed. What ingredients go into claims vetting and how monies are paid to providers after claims vetting, operation of the NHIS Claims Processing Centres etc.

4. 11 year journey of the NHIS, its achievements, challenges and way forward.

5. Membership and financial management

The NHIA has a mandate to run the NHIS by providing financial risk protection against the cost of basic healthcare for all residents in Ghana. 

In doing so, its work is subject to the work of other state institutions such as the auditor general and investigative bodies. And anytime that comes we fully cooperate as we are currently doing. 

The ongoing process, the NHIA believes will only produce an outcome that will improve the operations of the scheme.



GBC