Deputy Chief Executive Officer in charge of Operations at the National Health Insurance Authority (NHIA), Dr. Senanu Kwesi Djokoto, has warned that health facilities and individuals who charge patients illegal out-of-pocket fees under the National Health Insurance Scheme (NHIS) will face sanctions in accordance with the law.
Speaking to Isaac Addae on Morning Starr on Starr FM, Dr. Djokoto said the NHIA continues to receive complaints from patients who are charged for services they should not pay for under the scheme.
He acknowledged that some health facilities resorted to additional charges because of delays in reimbursement and concerns that the tariffs paid under the scheme were inadequate to cover their operational costs.
However the practice had, in some cases, become an established culture that could persist even after the underlying challenges were addressed.
“Sometimes when this becomes a culture or an accepted way of doing things, even when the challenges are fixed, it may continue,” he said
Dr. Djokoto said the NHIA was strengthening its sanctions regime to ensure that individuals and institutions found charging patients illegally are held accountable.
He disclosed that the authority had received calls for some health facilities to be suspended and for further investigations into others over alleged illegal payments.
“I can tell you confidently that people would be dealt with appropriately according to the laws of this country for doing what they are not supposed to do,” he stated.
As part of efforts to tackle the practice, he said the NHIA had established an anti-fraud and illegal payments directory to strengthen its response to complaints and improve public participation in identifying violations.
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He added that the authority was also intensifying efforts to prevent and detect fraudulent claims by healthcare providers, particularly those who deliberately inflate claims to obtain more money from the national health insurance fund.
Dr. Djokoto warned that such practices undermine the scheme and deprive other patients of resources that could have been used to provide essential health interventions.
He said the NHIA was reviewing its contracts with healthcare stakeholders while strengthening engagement to ensure that providers understood and complied with the rules governing the scheme.
Dr Djokoto acknowledged that ending illegal out-of-pocket payments would require sustained enforcement and a change in the practices that had become entrenched in parts of the healthcare system.
“Ending this will not be a walk in the park. It won’t be by one proclamation stressing the need for consistent efforts to eliminate the practice”he said “
He called for cooperation from healthcare providers and the public as the authority works to protect NHIS members from charges they are not legally required to pay.
Story By Pamela Quayson
