The Akim Oda Government Hospital in Ghana's Eastern Region has been directed to refund GH¢312,413.51 to the National Health Insurance Authority (NHIA) following the discovery of fraudulent claims submitted under the National Health Insurance Scheme (NHIS).
This directive was issued after a whistleblower report prompted NHIA Chief Executive, Dr. Victor Asare Bampoe, to initiate a comprehensive audit in accordance with the National Health Insurance Act. A multidisciplinary team was assigned to review claims filed by the hospital between February and May 2025.
The audit revealed several irregularities, including inflated claims for medications that were never dispensed and charges for services that should have been free for NHIS beneficiaries. The hospital also misapplied catering-inclusive tariffs, despite being categorized as a catering-exclusive facility, further inflating its claims.
Over a 16-month period, the hospital reportedly submitted more than 120,000 claims totaling GH¢47.6 million. The audit team identified a consistent pattern of overbilling, particularly for pharmaceuticals, and flagged the inappropriate prescription of certain drug classes, including antibiotics and opioids.
In a statement, the NHIA declared:
“The Authority will not tolerate breaches that undermine public confidence in the National Health Insurance Scheme. The facility is hereby directed to refund GH¢312,413.51 for various breaches and irregularities identified in claims submitted.”
Additionally, the NHIA has ordered the hospital to cease all out-of-pocket charges to NHIS members for services already covered under the scheme. Moving forward, all claims submitted by the facility from May 2025 will undergo more rigorous validation processes.
Source: Theghanareport.com
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