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.

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.