NHIS Withdraws Accreditation Of Fraudulent Service Providers

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Management of the Northern Regional National Health Insurance Scheme (NHIS) has grabbed 17 service providers for fraudulent deals.

Some of them have had their accreditations withdrawn whilst others have been forced to refund monies they received from the NHIS for no work done.

These identified confidence tricksters include some district hospitals across the Northern Region.

Senior Monitoring and Evaluation Officer at the Northern Regional NHIS secretariat, Augustine Boakye exclusively divulged this to Citi News in an interview.

He was reacting to allegations made by majority of NHIS service providers and licensed chemical sellers that the National Health Insurance Authority (NHIA) owed them billions of cedis for which reason they withdrew their services.

He said the fraudulent deals were detected after a clinical audit was conducted on already paid claims submitted by NHIS service providers and licensed chemical sellers across the region.

“There are instances where we have had clinical auditing going to audit claims submitted to us and we have identified some of these claims to be full of errors.”

He stressed, “There are instances where some of the claims are even fraudulent and in order to ensure that we have value for money we go through this rigorous claims
vetting process.”

Augustine Boakye said management was committed to paying for genuine services rendered to NHIS subscribers.

The regional NHIS Information Communication Technology Coordinator, Ndo Emmanuel Setonyo attributed the delays in reimbursing the service providers and licensed chemical sellers to late submission of NHIS claims.

He also indicted the service providers and licensed chemical sellers for clerical errors usually detected on their claims.

“We want to assure that by way of expediting claims payment in a very good time the authority has made arrangement to go electronic where some service providers are able to submit claims electronically.”

He explained, “Once the claim is submitted electronically the delays in vetting will be taking care of and the claims system will not accept errors during the submission.”

He said the NHIS will continue to follow due diligence in reimbursing all their service providers and licensed chemical sellers in the region.

“We are thinking of the biometric which will also tackle the provider shopping that our subscribers do to ensure that whoever’s claim is submitted the person actually went to the provider post for care.”

He also indicted the service providers and licensed chemical sellers for clerical errors usually detected on their claims.

“We want to assure that by way of expediting claims payment in a very good time the authority has made arrangement to go electronic where some service providers are able to submit claims electronically.”

He explained, “Once the claim is submitted electronically the delays in vetting will be taking care of and the claims system will not accept errors during the submission.”

He said the NHIS will continue to follow due diligence in reimbursing all their service providers and licensed chemical sellers in the region.

“We are thinking of the biometric which will also tackle the provider shopping that our subscribers do to ensure that whoever’s claim is submitted the person actually went to the provider post for care.”

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