Massive fraud uncovered in NHIS

…Scheme Managers, Accountants involved
Posted: The Chronicle |Tuesday, January 05, 2010

By Charles Takyi - Boadu

An audit report commissioned by the National Health Insurance Authority (NHIA) has uncovered massive fraud, which threatens to undermine the fortunes of the country’s National Health Insurance Scheme (NHIS).
The fraud, which involves various sums of money, were detected in the Volta and Brong Ahafo regions, where Managers of some Mutual Health Insurance Schemes (MHIS) and their Accountants and other related staff dissipated resources without following standard procedures.

In the North Tongu of the district of the Volta region for instance, the audit uncovered cases of financial fraud involving the Scheme Manager, one Isaac Fenu and his Accountant, one Simon Goka. The Manager was said to have colluded with the Accountant of the Adidome government hospital to defraud the Scheme and the hospital of an amount of GHC 7,000.00.

The Scheme Accountant and his Manager were said to have issued two cheques amounting to GH¢ 7,000.00 to the hospital accountant, one Evans Agbefu, which the latter cashed and failed to pay into the hospital account. Consequently, the NHIA has resolved to report the fraudulent conduct of the hospital accountant to the regional Police command for action.

Furthermore, the report revealed that the Scheme Accountant and the Manager of the North Tongu MHIS failed to account for another whooping GH¢ 27,836.00 of premium collected. Both individuals have thus been interdicted and asked to step aside for further investigations. In spite of that, they have also been asked to refund the monies involved.

In Adaklu-Anyigbe district, the audit also revealed cases of financial malfeasance in claims payments, involving three of the Scheme officers including Raybon Evans Anyadi, who happed to be the Scheme Manager, Jerry Agbanu, the Accountant and one Bright Nyatsikor, the Claims officers.

A total amount of GH¢ 28,537.73 meant for the payment of claims to service providers was misappropriated by the Scheme officials, whilst cheques for payments of claims were also cashed by these officials. The Authority has thus directed the interdicted and subsequent arrest and investigation of the Scheme Manager, Claims Manager and the Accountant altogether.

Also in the Broong Ahafo region, the Scheme Manager of the Jaman North MHIS and his Accounted have been interdicted with immediate effect, pending full-scale investigations to reveal their scale of mismanagement and incompetence. The two are accused of misapplying an amount of GH¢ 25,944.00 to purchase computers and accessories and misappropriating other funds to the tune of GH¢ 12,000.00.

In its present state, the Scheme is said to have locked up a whooping GH¢ 52,720.00 in printing identity cards, security renewal stickers and making identity card wallets. Moneys from its Claims account were said to have been used to make these payments.

In the case of the Wenchi MHIS, the following service providers; Email Methodist Hospital, Wenchi Methodist Hospital, Subinso Health Centre, Nyaase Royal Maternity Home and Droboso clinic were noted to have overpaid by a total amount of GH¢ 57,932.13.

Meanwhile, the NHIA is undertaking further investigations to ascertain the circumstances under which the excesses occurred, stressing that ‘any omission, negligence or collusion would be punished appropriately.’

At the Nkoranza MHIS, there was the issue of front-loading of provider, where the previous board approved a loan of GH¢ 20,000.00 for Mount Olives, a service provider located in Techiman in January 2009.

Deductions were said not to have been until August 2009 when GH¢ 1,500.00 monthly deductions commenced. However, The facility has, however, been made to refund the amount involved.

Startling revelations of NHIS

SHS GRADUATE DISPENSING MEDICAL SERVICE
… Offers consultancy and administers treatment
Posted: The Chronicle |Tuesday, January 05, 2010

By Charles Takyi - Boadu

Issues have started emerging over services rendered by some of the country’s health facilities for the National Health Insurance Scheme (NHIS). A report issued by the National Health Insurance Authority (NHIA) makes startling revelations of how a Senior High School (SHS) graduate has been dispensing treatment at a health facility in Adidome, Biodum, in the Volta Region.
It also uncovered serious cases of professional misconduct and malfeasance against health facilities whose accreditations have since been suspended. According to the findings of the report, there were no qualified staff at the time of the visit by the audit team, while the person attending to about 40 patients, was a Senior High School graduate who was consulting and giving treatment.

That notwithstanding, there were no records of attendance for most patients, and records available were written in exercise books.

Hypertensive and diabetic patients were also treated at the maternity home, while expensive medications such as Tablet Losartan were prescribed and dispensed, even though the facility has no pharmacist or dispensing technician.

The midwife was said to have offered eye services and billed the Scheme, though the facility has not been accredited for such services.

At the Hoggar Clinic, the report also revealed that some multiple attendances could not be traced to the patients’ folder. For instance, medical notes indicated single visits, whilst on the Claims forms the Scheme was billed for multiple visits.

There were also some incidences of what the report described as poly-pharmacy in about half of the Claims sampled, whilst serious discrepancies existed between diagnosis and treatment in almost 80% of the Claims sampled.

Also at the St. Paul’s Hospital in Akatsi, in the same Volta Region, the report revealed that the doctor engages the services of unqualified persons as medical staff, with the only qualified staff at the facility being a locum student nurse, and one midwife on outreach services.

A student nurse assisted surgical operations performed at the facility. For this reason, the authority could not but state that “quality of care to patients is seriously compromised.”

In spite of that, the dispensary and the laboratory had no qualified staff, with serious cases of poly-pharmacy and some multiple attendances could not be traced to patients’ folders.

The next stop of the team was the Crown Pharmacy in Ho, where prescriptions were said to have been altered, indicating that medicines that were originally not on the prescriptions from the doctor were added.

In addition, the strengths of the medicines served, were also said to have been changed to attract higher prices.

The Sefe Clinic was also said to have no medical officers.

Two other pharmacies, Truth Pharmacy at Kadjebi, and Secure pharmacy at Hohoe, were found to be providing clinical services to patients.

This has compelled the Authority to report their conduct to the Pharmacy Council for practising clinical services without a license.

Furthermore, the audits revealed some few cases of poly-pharmacy at the St. Patrick Hospital in Kpando, and the authorities have been cautioned to desist from the practice.

Certain government health facilities were equally found with some levels of professional misconduct and malfeasance, which have been reported to the Director-General of the Ghana Health Service (GHS) for appropriate sanctions to be applied.

They include the Adidome Government Hospital, for billing some medications to the Scheme, which were not in the patients’ folders, and also for billing the Scheme separately with infusion sets, syringes and needles.

That notwithstanding, nurses and midwives were accused of prescribing treatments which were recorded on the medication list, whilst such treatments were not in the doctors treatment records of such patients.

At the Sogakope Government Hospital, the Authority discovered that infusions billed for at the maternity units, were neither in the nurses’ report notes nor in the patients’ folders, whilst the hospital charged separately for infusion sets.

In the case of the Peki Government Hospital, some services believed to be ‘detention for observation,’ were said to have been captured as in-patient services, and were billed as such, whilst the Anfoega Catholic Hospital has been without a qualified medical officer over a long period of time.

The NHIA has indicated its readiness to conduct a full-scale clinical audit to establish the extent of over-billing, in order to enable the Authority demand appropriate refund, and accordingly apply sanctions.