THE COUNTY Hospital and Atasomanso Hospital, both in Kumasi in the Ashanti Region, have been suspended from serving as health providers for the National Health Insurance Scheme (NHIS), to its subscribers.
The two private hospitals are alleged to have defrauded the scheme by indulging in multi billing and providing poor quality health care, among others.
Sylvester A. Mensah, acting Chief Executive of the National Health Insurance Authority (NHIA), disclosed this to the press in Accra yesterday.
The scheme’s management, Mr. Mensah stressed, had therefore suspended the Atasomanso and County hospitals from providing services to NHIS subscribers for a period of three months.
“All NHIS members should therefore desist from visiting the two facilities for medical care as cases attended to during the period of suspension will not be reimbursed by the schemes”, he said.
He said the hospitals had in some instances claimed wrong and higher tariffs for diagnoses which their audited clinical notes did not match.
In cases where patients were admitted for a few hours, he noted, the hospitals put in an additional bill for three outpatient visits for the same patient including medicines which were supposedly prescribed and dispensed.
“Clearly, the activities of these two hospitals constitute serious financial leakages on the Scheme that must be stopped”, he added.
According to Mr. Mensah, the two hospitals appealed against the decision and the NHIA’s findings were subjected to a review by healthcare professionals drawn from the private and public sector.
In a related development, the Manager and Accountant of the Ga District Health Insurance Scheme at Amasaman in the Greater Accra Region have been asked to step aside for thorough investigations to be conducted into the operations of the scheme.
The NHIA boss averred that financial and claims audits done on the Ga Mutual Health Insurance Scheme covering the period January 1, 2007 to December 3, 2008 revealed several anomalies ranging from misapplication of funds.
Other problems such as the inability of the scheme to account for monies, poor controls/conflicts of interest and weaknesses in organizational processes as well as outright incompetence on the part of the management of the scheme were also detected.
He said the authority was ready to provide quality care to NHIS members, hence the need for it to take a serious stand on the matters affecting the operation of the scheme.
“I dare say that the NHIA will deploy all means at its disposal to ensure that perpetrators of acts that seek to undermine the sustainability and integrity of the NHIS as well as compromise the quality of care offered NHIS members, are brought to book”, he assured.
By Henrietta Abayie/Daily Guide
Friday, August 21, 2009
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