The National Health Insurance Authority (NHIA) has sanctioned the Akim Oda Government Hospital in the Eastern Region following findings of widespread irregularities in its claims submissions to the Authority.
A Clinical and Compliance Audit report has directed the hospital to refund an amount of GH¢312,413.51, representing funds wrongfully received as reimbursements under the National Health Insurance Scheme (NHIS).
The audit was sanctioned by NHIA Chief Executive, Dr. Victor Asare Bampoe, after a whistleblower petition alleged fraudulent practices at the facility between February and May 2025. The investigation was carried out from July 14 to 18, 2025, by a multidisciplinary team drawn from NHIA’s Quality Assurance and Internal Audit directorates, the Claims Processing Centre (CPC) in Accra, and an external clinician.
The probe revealed multiple breaches in the hospital’s operations, including:
• Variances between medicines dispensed and those billed to the NHIA.
• Overbilling of certain drugs and inappropriate prescribing practices, especially with antibiotics, opioids, and anticoagulants.
• Application of catering-inclusive tariffs, although the hospital is credentialed as a Public Primary Hospital (catering-exclusive).
• Illegal demands for out-of-pocket payments from NHIS members for services already covered by the Scheme.
According to the report, these practices not only inflated claims but also burdened patients financially in direct violation of NHIS regulations.
“The Authority will not tolerate breaches that undermine public confidence in the National Health Insurance Scheme (NHIS). The facility is hereby directed to refund GH¢312,413.51 to the NHIA for various breaches and irregularities identified in claims submitted,” the sanctioned report stated.
Between January 2024 and April 2025, the hospital submitted 120,589 claims worth over GH¢47.6 million to the NHIA. The audit revealed several discrepancies within these submissions, casting doubt on the integrity of the facility’s claims system.
As part of the recommendations, the hospital has been directed to desist from demanding illegal co-payments and to ensure all subsequent claims are thoroughly validated before submission.
The development comes at a time when the NHIA has been stepping up its fight against fraudulent claims and illegal charges by some health facilities. In recent years, the Authority has introduced routine clinical and compliance audits across the country to safeguard the Scheme’s financial sustainability.
In 2023, similar audits uncovered widespread malpractices in parts of the Ashanti and Northern Regions, leading to refunds and sanctions against some hospitals. Health analysts have long cautioned that fraudulent billing practices and illegal co-payments erode public confidence in the NHIS and threaten Ghana’s goal of achieving Universal Health Coverage (UHC).
The government, through the uncapping of the National Health Insurance Levy (NHIL), has ensured more regular and timely release of funds to the NHIA, a move that has kept the Authority largely debt-free in its payments to service providers since 2024. In return, the NHIA has pledged to tighten oversight and accountability measures to ensure funds are used for their intended purpose.
Since assuming office, Dr. Bampoe has consistently emphasised strict financial controls, accountability, and transparency in NHIS administration. He has urged all service providers to desist from charging patients illegal co-payments, warning that the Authority will not hesitate to sanction defaulters.
“The audit identified non-compliance with regulations and directives. Appropriate recommendations have been made to improve the NHIS and to ensure the financial sustainability of the Scheme,” the Akim Oda audit report concluded.
Source: Starrfm.com.gh
