A CLINICAL audit of claims submitted by service providers to the Eastern Regional Office of the National Health Insurance Scheme (NHIS) saved the office from paying GH¢100,000 that would have gone down the drain.
The Eastern Regional Manager of the NHIS, Mr Windham Emil Afram, made this known at a peer review meeting in Koforidua last Thursday.
He did not, however, indicate which particular health service providers that submitted the fictitious and false claims.
Mr Afram assured the gathering that his outfit would continue to scrutinise every claim submitted to ensure that the correct claims from service providers were paid.
The one-day meeting, which was attended by district managers and other top officials of the scheme, was to examine the inherent challenges of the scheme in the region and strategise for the future.
Mr Afram said although there had been some anomalies in the book keeping processes of the scheme which were addressed, no financial malfeasance was identified when the clinical audit was conducted on claims submitted in the first quarter of this year.
He stated that in recent times, service providers in the region had few or no complaints in respect of claims payments, adding that GH¢31,142,027.46, which was released by the government from January to August this year to pay claims, had been disbursed to most of the service providers.
Mr Afram praised the government for its commitment to the sustainability of the scheme, noting that such commitment would sustain the scheme and make it possible for the poor to continue to access quality healthcare.
With regard to the issuing of new identity cards for the scheme, he said with tremendous improvement in the process, cards for all those who registered six months ago had been made available for distribution.
He also announced that mass registration of new members during traditional festivals and market days in the region was ongoing.
Mr Afram mentioned Akuapem North, East Akyem, Kwahu North, Atiwa, Yilo Krobo and Manya Krobo as districts where the mass registration was about to be completed, while Kwahu West, Kwahu South, New Juaben and Fanteakwa would soon be tackled.
On the proposed one-time premium, he stated that it was feasible and that its modalities would be outlined by the close of the year.
He expressed his appreciation to the Eastern Regional Minister, Mr Samuel Ofosu-Ampofo for his personal commitment, as well as the Regional Co-ordinating Council, that had made it possible for the scheme to gain grounds in the region.
The Deputy Eastern Regional Minister, Mr Baba Jamal Mohammed Ahmed, said the NHIS was on the verge of collapse when the National Democratic Congress administration took over the reins of government.
He said, for instance that the Eastern Regional Hospital in Koforidua had GH¢1,089,768.53 in outstanding claims as of the end of May this year, while those of the Korle Bu Teaching Hospital stood at GH¢2.7 million.
Mr Baba Jamal said the government, therefore, had to institute prudent measures to clear the outstanding bills and also purge the system of illegitimate claims.
The deputy regional minister asked the scheme managers to eschew all forms of corrupt practices to ensure the sustainability of the scheme.
He, however, praised them for their high performance that had sustained the scheme in the region.
The National Operation Manager of the NHIS, Mr William Okyere, commended managers of the scheme in the region for their efforts at detecting fraud in the payment of claims, while the Head of the Audit Unit, Mr George Omaboe, directed them to furnish his outfit with the necessary documents on all past directors to make it possible to process their end-of-service benefits.
A representative of the Eastern Regional Directorate of the Ghana Health Service, Dr Addo Larbi, who also spoke at the meeting, urged the managers not to do anything that would lead to the collapse of the scheme in the region.
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