The Public Accounts Committee of Parliament has expressed concern about the misappropriation of funds by officials of the National Health Insurance Authority (NHIA) and urged the management to recover with interest all misappropriated funds.
It has also called for a restructuring of the operations of the NHIA to ensure efficient and effective claims management within the National Health Insurance Scheme (NHIS).
The committee’s recommendations were contained in a report it submitted to Parliament yesterday after studying the Performance Audit report of the Auditor-General on the management of claims by the NHIS.
The report was adopted by the House.
Presenting the report, the Chairman of the committee, Mr Kwaku Agyeman-Manu, said the committee observed, after studying the details of investigations conducted by the Auditor-General in 2010, that GH¢ 6.4 million was misappropriated from 2005 to 2009. Overpayments for the same period totalled GH¢ 22million.
He said the committee found out that the misappropriation occurred mostly through malpractices such as the insertion in the claims form of drugs not prescribed, creation of claims in respect of persons who did not attend hospital, overstatement of claims and prescriptions not serialised.
According to him, the committee learnt that the NHIA had, through the Attorney-General, instituted 10 criminal prosecutions against culprits; out of which eight were ongoing and two discontinued.
With regard to overpayment, he said officials of the NHIA informed the committee that measures had been put in place for the recovery of overpayments through retrospective vetting of all claims paid.
To that end, he said the NHIA recovered GH¢ 8.4 million out of the GH¢ 22 million.
The monies that were recovered, he added, were mostly from payments that arose out of pure errors and not fraudulent acts.
Mr Agyeman-Manu said an officer of the NHIA who was found to be involved in the overpayment of claims had been convicted by the courts. Furthermore, about 100 hospitals were found wanting in the clinical audit and had had their accreditation withdrawn by the NHIA.
In spite of the NHIA putting in measures to recover the monies, he said the committee found the situation to be unacceptable.
According to him, the committee found that officers in charge of vetting and paying claims at the District Mutual Health Insurance schemes did not have the requisite training and skills, a situation which brought their competence into disrepute.
“The committee, therefore, urges the management of the NHIA to pursue the pending court cases with the seriousness they deserve,” he added.
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