The National Health Insurance Authority (NHIA) has saved the nation from losing a colossal amount of GH¢1.3 million from service providers in the northern region in the year 2020.
The amount was realized during scrutiny of claims submitted to the NHIA Claims Processing Centre in Tamale for payment by government to the service providers.
The Deputy Director for the Claims Processing Centre (CPC), Mr. Isaac Gideon Akonde disclosed this in an exclusive interview with THE CUSTODIAN during the Northern Region 2020 End of Year Review Meeting in Tamale last Thursday.
He said the Authority received GH¢29.9 million value of claims from service providers last year in the northern region and the CPC during vetting could not validate GH¢1.3 million of the claims due to some technical errors or deliberate attempts from the providers to fleece the state.
“The claims would come with some errors, some of them are technical errors and some of them too maybe deliberate that the providers are making to gain from the system but when we look at it with the technical people we have there, people that have clinical background, we understand what goes on at the provider ends.
“So we realize that, you have a claim that comes and the medicine that is given to the patient doesn’t in anyway correspondent with the diagnosis for the patient. For example, you’re treating somebody with malaria, you diagnose the patient with malaria but you are giving hypertension medicines to the person, so those hypertension medicines would be taken off, it would be deducted, it won’t be paid”, Mr Akonde stated.
He added that a significant number of the claim forms also come with wrong NHIA card numbers and when checked in their database, either the numbers do not exist or the numbers are completely wrong.
According to him, what it means is that whilst they were entering it, someone didn’t capture numbers well and those are the errors they have done and some of them maybe deliberate or inadvertent.
“So if the claims were just received and then the authority is paying, then the state will be losing in excess of 1.3 million cedis for only the northern region” Mr. Akonde stressed.
Meanwhile, the Deputy Director further revealed that over GHS6 million unfounded claims were also detected during the claims vetting process for the five regions in the north in the year.
He said the NHIA has also taken legal actions against some of the providers for defrauding the state even though he did not mention names of these fraudulent organizations.
“And so we are advising that, the providers need to go by the protocols when it comes to service provisions, when it comes to generating their claims, because any cedi that we save from the National Health Insurance can actually help save the life of a Ghanaian”, he entreated.
