The Akim Oda Authorities Hospital within the Jap Area has been directed to refund GH¢312,413.51 to the Nationwide Well being Insurance coverage Authority (NHIA) after a scientific and compliance audit uncovered widespread irregularities in its claims submissions.
The audit, commissioned by NHIA Chief Govt Dr Victor Asare Bampoe, adopted a whistleblower report alleging fraudulent practices on the facility between February and Could 2025. A multidisciplinary group—comprising NHIA’s High quality Assurance and Inner Audit models, the Claims Processing Centre in Accra, and an exterior clinician—carried out the investigation from July 14 to 18, 2025.
The evaluate revealed a number of malpractices, together with:
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Because of this, the NHIA directed the ability to refund the overpaid quantity and warned towards additional breaches.
The report said.
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The Authority won’t tolerate practices that undermine public confidence within the Nationwide Well being Insurance coverage Scheme (NHIS)
Between January 2024 and April 2025, the 162-bed facility submitted 120,589 claims price GH¢47.6 million. Nonetheless, the audit recognized inflated claims, inappropriate billing practices, and non-compliance with NHIA laws.
The report additional instructed that every one claims from Could 2025 onwards be subjected to stricter validation earlier than reimbursement.
The NHIA emphasised that this audit is a part of broader reforms to strengthen monetary accountability, forestall fraud, and safeguard the sustainability of the scheme. Dr Bampoe reiterated his administration’s dedication to transparency, monetary self-discipline, and eliminating unlawful co-payments.
He famous that the federal government’s well timed launch of funds and the uncapping of the Nationwide Well being Insurance coverage Levy (NHIL) have positioned the NHIA in a debt-free standing on claims, stressing that such funds should at all times be used responsibly.
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The Authority pledged to proceed conducting compliance audits nationwide to guard NHIS members from exploitation and guarantee high quality healthcare supply.
