Health News of Friday, 17 January 2014
The Chief Executive Officer of the National Health Insurance Authority (NHIA), Sylvester Mensah has admitted the Scheme is currently facing serious challenges.
Mr. Mensah says the scheme is bedeviled with what he calls demand and supply challenges, which must be addressed.
He was addressing a forum on health insurance capitation in Accra.
Joy News' Anna Agyepong reported that the NHIA boss cited instances where providers sometimes use names of subscribers in good standing forge judicious claims and submit them for payments.
Investigations the authority conducted also revealed claims by providers for subscribers visiting two or three health facilities at the same time in the same month, Mr. Mensah indicated.
He also highlighted the fact that some providers share data and for so doing inflate their claims.
Other irregularities further highlighted by the NHIA boss is the authority's clinical audit that shows information on hospital folders do not tally with the claim forms from the service providers.
The Ashanti region was cited as the worst affected region with inflated claims from service provider as with a 19% total membership in 2010, their claim forms indicate 30%.