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National Health Insurance Scheme


NHIS pays over ¢6m claims to service providers in UWR|8/22/2019

The Upper West Regional Operations Manager for the National Health Insurance Authority (NHIA), Samuel Lobber Lekamwe, has disclosed that over ¢6 million has been paid to service providers in the region last week.

He said more funds had been released for payment as claims for service providers, as indicated by the Chief Executive Officer (CEO) of the authority.

Speaking in an interview in Wa, he said the amount covered claims of arrears for about 319 service providers in the region.

Mr Lekamwe said in this year alone, the authority had paid several millions of Ghana Cedis to service providers in the region as part of efforts to sustain the scheme to ensure that healthcare delivery was not interrupted.

“Majority of the facilities in the region have been paid up to November 2018, which is unprecedented, and those that have been paid in advanced are up to December 2018,” he said.

“By law, a claim gets matured after it has been submitted for 90 days, so what it means is that, claims that are less than 90 days are not qualified to be called indebtedness to the NHIA, … invariably this means that we have five months claims not paid,” he explained.

According to him, government was investing massively to improve quality healthcare delivery and appealed to service providers to deliver quality services to clients.

He asked them to submit genuine claims and make concerted efforts to control the disease burden to help save enough resources for other development initiatives.

Mr Lekamwe, however, lamented that in spite of the huge payments, some facilities still charged clients when they visited the facility to access service delivery, including referring them to stand-alone diagnostic centres for laboratory tests, which were covered by their credentialing with NHIS.

The practice, he said, was causing huge financial loss to the state as government paid for all-inclusive services provided at the facility.

“We are seeing situations where members are being referred from hospitals to stand-alone diagnostic centres to conduct lab investigation even though such facilities have been credentialed to carry out those services,” Mr Lekamwe bemoaned.

He added that any issues of fraud or illegalities established against a service provider would result in the authority terminating all credential agreements with that facility and the necessary punitive action taken against it.

He also noted that the authority had obtained a fiat from the Attorney General and had employed the services of lawyers to augment the legal department to prosecute cases related to the authority.

Mr Lekamwe, thus, urged the public to report to the authority anytime they visited the facility and were asked to pay for services covered by the scheme including lab tests and paying for drugs. 


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