The Akim Oda Government Hospital in the Eastern Region has been directed to repay GH¢312,413.51 to the National Health Insurance Authority (NHIA) following a Clinical and Compliance Audit report that exposed malpractices in the hospital’s operations and claims submissions.
Prompted by a whistleblower report that alleged fraudulent activities at the hospital from February to May 2025, NHIA Chief Executive Dr. Victor Asare Bampoe authorized the audit in accordance with Sections 31(1) and 35(2) of the National Health Insurance Act (Act 852).
Conducted by a team including members from NHIA’s Quality Assurance and Internal Audit departments, Claims Processing Center (CPC) Accra, and an external clinician, the investigation spanned from July 14 to 18, 2025.
The audit findings highlighted numerous irregularities in the claims submitted by the hospital for reimbursement. These discrepancies encompassed discrepancies in medicines dispensed versus those charged, inflated pricing for specific medications, and inappropriate prescribing practices related to antibiotics, opioids, and anticoagulants.
Furthermore, the hospital misapplied catering-inclusive tariffs and requested out-of-pocket payments from NHIS members for services that should have been covered. Consequently, the NHIA has mandated a refund of GH¢312,413.51 to the Authority and urged rigorous validation of future claims to prevent recurrence of such breaches that undermine public trust in the National Health Insurance Scheme (NHIS).
Despite being accredited as a Public Primary Hospital with catering-exclusive designation, the audit revealed that catering-inclusive tariffs were erroneously applied throughout the review period, leading to inflated claims.
In addition to the refund, the report prescribed that the hospital cease demanding out-of-pocket payments from active NHIS members for covered services and ensure diligent validation of subsequent claims.
Over a 16-month period from January 2024 to April 2025, the Akim Oda Government Hospital, with a 162-bed capacity, submitted a total of 120,589 claims amounting to GH¢47,645,535.00.
However, the audit uncovered various discrepancies including medications billed but not dispensed, overbilling of pharmaceuticals, and inappropriate prescribing practices.
The NHIA reiterated its commitment to overseeing healthcare facilities to enhance patient outcomes, improve healthcare access, and sustain the financial stability of the Scheme.
The Executive Management affirmed its dedication to ongoing clinical and compliance audits across health facilities to uphold NHIS integrity and ensure members access scheme benefits without exploitation.
Dr. Victor Asare Bampoe, in his role as NHIA Chief Executive, has emphasized financial controls, accountability, and transparency to maintain NHIS integrity.
He has pledged to eliminate financial barriers to healthcare and curb illegal charges and fraudulent claims to bolster public confidence in the Scheme and advance President Mahama’s vision for Universal Health Coverage (UHC).
By releasing funds for claims payment in a timely manner and combatting challenges such as ‘co-payments’ and fraudulent claims, Dr. Bampoe seeks to fulfill the government’s commitment to ensuring NHIS funds are utilized for their intended purpose and rebuilding trust in the healthcare system.