Akim Oda Government Hospital in the Eastern Region has been directed to refund GH¢312,413.51 to the National Health Insurance Authority (NHIA) after an audit uncovered alleged fraudulent practices in its submission of claims.

The Clinical and Compliance Audit was ordered by NHIA Chief Executive, Dr Victor Asare Bampoe, following a whistleblower report alleging fraudulent practices at the facility between February and May 2025.

According to a 3news.com report on August 20, 2025, a multidisciplinary team from the NHIA’s Quality Assurance and Internal Audit directorates, the Claims Processing Centre in Accra, and an external clinician conducted the exercise from July 14 to 18, 2025.

The audit revealed several irregularities including discrepancies between medicines dispensed and those billed, overbilling of certain drugs, and inappropriate prescribing of antibiotics, opioids, and anticoagulants.

It also found that the hospital wrongly applied catering-inclusive tariffs despite being credentialed as a catering-exclusive facility, leading to inflated claims.

The report further noted that some National Health Insurance Scheme (NHIS) members were made to pay out of pocket for services covered by the scheme, contrary to NHIA policy.

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“The facility must desist from asking active NHIS members to make out-of-pocket payments for services covered by the Scheme. Subsequent claims, starting from May 2025, should be thoroughly validated before reimbursement,” the report said.

The Akim Oda Government Hospital, a 162-bed facility, submitted 120,589 claims valued at GH¢47.6 million between January 2024 and April 2025.

However, significant discrepancies were identified during the audit.

As part of its directives, the NHIA ordered the refund of GH¢312,413.51, instructed the hospital to desist from charging NHIS members for covered services, and directed that all subsequent claims be thoroughly validated before reimbursement.

“The Authority will not tolerate breaches that undermine public confidence in the National Health Insurance Scheme (NHIS). The facility is hereby directed to refund GH¢312,413.51 to the NHIA for various breaches and irregularities identified in claims submitted,” the report stated.

Dr Bampoe emphasised that the NHIA would not tolerate breaches that undermine public confidence in the NHIS and reiterated the Authority’s commitment to safeguarding the scheme’s financial sustainability through regular audits nationwide.

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