The National Health Insurance Authority (NHIA) has instructed the Akim Oda Government Hospital in the Eastern Region to refund GH¢312,413.51 after an audit uncovered fraudulent claims made under the National Health Insurance Scheme (NHIS).
The directive followed an investigation triggered by a whistleblower report, which prompted NHIA Chief Executive Dr. Victor Asare Bampoe to commission a full audit in line with the National Health Insurance Act.
A multidisciplinary team reviewed claims filed between February and May 2025 and found several discrepancies.
According to the audit, the hospital had submitted inflated claims for medications not dispensed and charged for services that should have been free for NHIS members.
There were also errors in the application of catering-inclusive tariffs, even though the facility is registered under a catering-exclusive category.
These billing issues significantly increased the hospital’s claims.
Over a 16-month period, the hospital submitted more than 120,000 claims amounting to GH¢47.6 million.
The audit team discovered patterns of overbilling for pharmaceuticals and inappropriate prescriptions of certain drug classes, including antibiotics and opioids.
A statement from the NHIA noted, “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”.
Meanwhile, the NHIA has also ordered the hospital to stop requesting out-of-pocket payments from NHIS members for services covered under the scheme, while future claims will undergo stricter validation starting from May 2025.
