NHIA Rolls Fraud Detection System


By Cecil Mensah

The National Health Insurance Authority (NHIA), has indicated that it would by next year introduce a Unique Prescription Form (UPF) with serial numbers and subscriber’s numbers to help check fraudulent claims in the system.

According to the NHIA, no claims would be accepted from the various service providers under the scheme, without the UPF, if the new measures to check fraud are rolled out into the system.

The managers of the NHIS has said that the UPF has unique features that would be assigned to all the service providers under the scheme with subscribers’ serial numbers among other things.

Sylvester Mensah, the Chief Executive Officer (CEO) NHIA gave this hint when the Minister of Health, Dr. Kwaku Agyemen Mensah and officials of the Ministry of Health, paid a working visit to the offices of the authority in Accra on Monday.

The NHIA boss said, the introduction of the UPF was one of the key measures the authority is taking to check fraud and the inflation of figures.

He said, after the introduction of the UPF, Claims Processing Centre (CPC) would be established across the country to further manage the claims, noting that UPF and CPC come with improvements in claims management especially, detection of anomalies, errors and fraud.

This he hoped, would ultimately lead to a reduction in financial leakages and ensure faster claims processing.

He said, the authority has contracted Ghana Commercial Bank (GCB) and Agricultural Development Bank (ADB) to also manage the payment of subscription fees across the country to avoid scheme managers, keeping these monies and squandering it.

Speaking on the progress made, he said the number of people who visit the hospital has increased several folds.

“People do not feel inhibited going to the hospitals anymore because the major barrier to healthcare accessibility has been removed because financing healthcare has been taken care of by the NHIS” he said.

To him, the NHIS is undoubtedly the most successful health financing strategy the country has crafted to finance healthcare.

He explained that last year alone, out-patient utilization of NHIS rose to over twenty -seven million, indicating that more people now visit the hospitals. As a result, the authority paid over GH¢700 million in claims in 2013, as compared to over sixteen million Ghana Cedis in 2009 and over five hundred thousand Ghana Cedis in 2005.

He said, as part of prudent management, the authority has been able to acquire offices in the ten regional capitals and working to secure district offices too.

The Health Minister on his part, commended the management of the authority and urged them to intensify its education drive on the authority’s activities.

As part of the exercise, the Minister will be visiting some agencies under the Ministry such as, the Food and Drugs Authority (FDA), Central Medical Stores, Accra Psychiatric Hospital and Pantang Hospital.

The rest are Disease Control and Prevention Department, National Blood Service, Ridge Hospital and Dodowa (DHMT Hospital and CHPS zone) all in the Greater Accra Region.

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