More revelations at NHIS

HOW TEMA GEN. HOSPITAL, OTHERS FLEECED NATION OF GH¢130,000
Posted: The Chronicle |Wednesday, January 06, 2010

By Charles Takyi - Boadu

More revelations are coming out of an audit undertaken by the country’s National Health Insurance Authority (NHIA) into the activities and operations of some service providers of the National Health Insurance Scheme (NHIS).
Latest, is a clinical audit into certain health facilities, including the Tema General Hospital, which was found to have re-vetted and submitted claims for caesarean section and deliveries at the maternity unit, and over-billing to the tune of GH¢71,107.

This happened between the month of January and September 2009, when the hospital was discovered to have billed the Scheme with infusions and oxytocin, which were eventually not given to patients.

This was contained in a report issued by the Director of Claims at the NHIA, Dr Lydia Dsane Selby, in Accra.

The authorities of the hospital have been asked ‘to cough’ the said amount, whilst their conduct has been reported to the Director-General of the Ghana Health Service (GHS) for action.

A similar clinical audit undertaken by the NHIA, found the Sunyani Regional Hospital culpable of what the report describes as ‘spurious’ claims to the tune of GH¢57,335.64.

These were for drugs which were billed against the Scheme, but not found in the patients’ folder.

The hospital has also been asked to refund the money, whilst the issue has been referred to the GHS for appropriate sanctions.

At the Sunyani Municipal Hospital, the audit revealed that prescriptions of Tablet Simvastatin issued from the hospital and sent to Senti Chemist, had no records of patients’ attendance at the hospital.

The municipal hospital has been made to refund the amount involved, whilst at the St. John of God Hospital in Duayaw Nkwanta, a medical officer and medical assistants of the facility were noted to have prescribed the most expensive drugs for patients to buy at a particular pharmacy, Helen Pharmacy.

Though these prescriptions were said to have been sent to the pharmacy, they could however not be traced to the patients’ folders at the facility.

Meanwhile, the NHIA has decided to suspend service providers, including Bernice Maternity and Clinic at Yeji, Helen Pharmacy at Duayaw Nkwanta, Shabash Clinic in Goaso, Emil Memorial Hospital at Berekum, Akomade Clinic in Atebubu and the Menji Rural Clinic for various offences levelled against them.

In the case of Bernice Maternity and Clinic, the Authority alleged that a number of claims submitted for payment exceeded the clinic attendance records.

For instance, it was detected that a total of 4,601 claims were submitted for payment from August to October, but the clinic records showed 2,997 as the actual attendance, whereas Helen Pharmacy submitted huge claims in July and October 2009 in respect of the report described as ‘very expensive’ medication (Tablets Simvastatin 40mg).

In spite of this, it was uncovered that invoices of purchases of that particular medication fell short of the quantity supposedly issued out to patients, since the beginning of the year.

Furthermore, the folders of some patients’, on whose behalf claims had been submitted for payments, could not be traced at the facility.

In the case of the Shabash Clinic at Goaso, it came out that most of the 2nd and 3rd visits on the claims forms could not be traced in the patients’ folder, whilst there was evidence of inappropriate drug prescription, and drugs did not always match diagnosis.

The facility was again found to have billed the Scheme for drugs while the same prescriptions were sent to a particular accredited chemical shop (Nsiah Chemical Shop) for collection.

The Emil Memorial Hospital in Berekum was also noted to have billed the scheme for services not rendered.

In one instance, a claim was submitted for a patient said to have undergone a caesarean section, but upon verification, the Authority says it uncovered that the patient was still pregnant.

Considering the fact that the Akomade Clinic in Atebubu had no medical officer, while quality care was found to have been seriously compromised, it has been suspended from providing services to NHIS clients.

The Menji Rural Clinic was also found to be using unqualified staff at the maternity unit to attend to maternal cases, while prescribing 3rd level antibiotics for patients with simple infections.

Meanwhile, a recent audit undertaken by the National Health Insurance Authority at the Paradyse Clinic at Ejisu in the Ashanti Region has revealed that there were not enough washrooms, with in-patients and out-patients sharing the same facilities.

That notwithstanding, the hospital was noted to be overcrowded with what the report described as ‘very poor’ ventilation, stressing: “there were not enough qualified nurses on site, which compromises care.”

For this reason, the Authority has downgraded its status from a hospital to a clinic.

In all, seven members of staff of various Schemes have been interdicted, whilst 15 facilities have been suspended, with four people to be handed over to the police.

Another six health facilities are to be reported to the Director General of the GHS, while two more facilities are to be reported to the Christian Health Association of Ghana (CHAG) for action.