The National Health Insurance Authority (NHIA) has ordered the Akim Oda Government Hospital in the Eastern Region to refund GH¢312,413.51 after an audit uncovered fraudulent claims submitted for reimbursement under the National Health Insurance Scheme (NHIS).

The directive follows a Clinical and Compliance Audit conducted by the NHIA after a whistleblower report raised suspicions of malpractice at the hospital.

The audit, sanctioned by NHIA Chief Executive, Dr. Victor Asare Bampoe, was carried out between July 14 and 18, 2025, covering claims submitted between February and May 2025.

Audit Uncovers Multiple Irregularities

According to the audit report, investigators found significant discrepancies in claims filed by the hospital.

Medicines that were billed to the NHIA had not been dispensed, while some pharmaceuticals were overbilled.

In addition, the hospital engaged in questionable prescribing practices, particularly with antibiotics, opioids, and anticoagulants.

One of the most striking findings was that the hospital consistently applied catering-inclusive tariffs, even though it is credentialed as a Public Primary Hospital (Catering Exclusive).

This misclassification inflated claims and led to overcharging.

Furthermore, NHIS members were asked to make out-of-pocket payments for services that were already covered under the scheme — a clear violation of NHIA policy.

Refund and Sanctions

The NHIA has directed the hospital to refund the GH¢312,413.51 and to desist from imposing additional charges on insured patients. Future claims submitted by the hospital will now be subject to stricter validation.

“The Authority will not tolerate breaches that undermine public confidence in the NHIS,” the audit report stressed.

Scope of the Claims

The Akim Oda Government Hospital, a 162-bed facility, had submitted 120,589 claims between January 2025 and April 2025 totaling GH¢47,645,535.00.

The audit, however, revealed that many of these claims were irregular and inconsistent with the services actually delivered to patients.

Strengthening Oversight of the NHIS

The crackdown forms part of a broader effort by the NHIA to protect the financial sustainability of the scheme.

Since assuming office, Dr. Bampoe has made accountability and transparency his top priorities.

He has pledged to intensify compliance audits across the country to stop fraudulent claims and illegal charges.

“Funds must always be used for their intended purpose. Co-payments and fraudulent claims must be eliminated at all costs,” Dr. Bampoe emphasized, adding that such practices threaten the government’s goal of achieving Universal Health Coverage (UHC).

Government’s Commitment

The NHIA’s move comes at a time when the government has prioritized prompt and debt-free payments to health facilities.

According to Dr. Bampoe, the uncapping of the National Health Insurance Levy (NHIL) and regular release of funds by the Ministry of Finance have put the Authority in a stronger financial position to settle claims on time.

By tightening financial controls and sanctioning errant facilities, the NHIA hopes to rebuild public trust in the NHIS and ensure that patients receive healthcare without exploitation.