Officials at the Ashanti regional office of the National Health Insurance Authority say measures instituted to check payment of fraudulent claims by providers are yielding positive results.
They say the introduction of clinical audit program, backed by effective monitoring and evaluation, has resulted in zero unlawful claims over two years.
Regional Manager, Daniel Frimpong, describes as robust and rigid, administrative mechanisms he says will not allow unscrupulous managers of health facilities to dupe the state.
616 primary healthcare providers currently serve 1.710 million scheme subscribers in the Ashanti Region as at November 1, 2015.
Reports of service providers submitting fictitious claims for payment in other are rife in the media.
Mr. Frimpong and his colleagues are however patting themselves on the back for what they believe is progress from tough administrative systems to check fraud.
Officials say the system does not only detect potential risks but also ensure prompt and effective payment management across board.
Mr. Frimpong explains routine visits and audit operations of registered service providers are making a difference.
The directorate’s strict but effective evaluation and monitoring activities is proving reliable and impeccable for perpetration of fraud in the National Health Insurance Authority.
“We have a system – the clinical audit. It goes to the facility to check if certain things are not done well which causes some financial payment that is not supposed to be made but these things are operational issues so in situations like these we tell the providers what to do. That does not amount to fraudulent deals. M&Es [monitoring and evaluation] are always on the field – they go to provider sites to see what is going on. I have personally visited more than 500 provider sites in Ashanti region to make sure operations are well within the realms of what NHIS stands for,” Mr. Frimpong has revealed.
Mr. Frimpong is happy efforts to sanitize the system are making an impact.
“I believe the measures and controls that we have put in place in Ashanti region; we do post accreditation. Normally when we give credentials, we were not following up with post-credentials monitoring but it’s now part of our operation systems. We go there to check that things are done right so I can tell you that these controls are yielding”. Mr. Frimpong has said.
Meanwhile, the regional directorate has registered 500 children free in deprived Nwineso Number Two community in the Atwima Kwanwoma District, as part of the scheme’s corporate responsibility programs.
Mr. Frimpong hints of extending the gesture to more of such vulnerable communities and institutions like infirmaries.
Source: Myjoyonline.com
