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NHIA declares zero tolerance for false claims|3/19/2020

The Acting Director of Quality Assurance (QA) at the National Health Insurance Authority (NHIA), Mr. Ismail Osei, has declared zero tolerance for false entries as claims for reimbursement.

 

According to him, the NHIA in 2019 saved GHS5 million as deductions from false claims submitted by some service providers.“Last year alone, the directorate audited quite a number of facilities and we made a cost recovery of over GHS5 million. That was the amount deducted from payments made to provider groups that were audited.” 

 

“Since clinical audit has been up and running, we have managed, in the past, to put somebody behind bars for fraudulent activity.”In an exclusive interview, Mr. Osei reiterated the Directorate’s commitment to be extra vigilant in auditing submitted claims to combat abuse of NHIS resources.

 

He described Quality Assurance as a prerequisite for Universal Health Coverage (UHC) and reassured that the Directorate would continue to ensure that members of the National Health Insurance Scheme (NHIS) are satisfied with services provided by the over 4,500 credentialed health facilities in the country.“We are looking at attaining Universal Health Coverage with Quality Assurance of health care services.”

 

Mr. Osei further added that the Directorate frequently engages stakeholders, including service providers and NHIS members, to get feedback. He reminded NHIS members of their responsibility to get involved directly in the NHIS modus operandi by giving feedback to the NHIA in relation to their needs and expectations.

 

Source: ABDUL KARIM NAATOGMAH


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