Chief Executive of the National Health Insurance Authority (NHIA), Sylvester A. Mensah, has revealed that findings in the just released Auditor-General’s report largely pre-dated his tenure as Chief Executive of the NHIA. He said he inherited an NHIS that was fraught with a lot of operational and administrative inefficiencies.

Mr Mensah made the comment while responding to the 2012 Auditor-General’s report which covered the 2008 and 2009 operations of the NHIS on Citi FM on Tuesday.

According to him, “the scheme under the NDC regime has seen tremendous growth in all its key performance indicators.” And that the NHIS has since experienced radical reforms making the scheme today significantly different with improved systems, structures, and strategies that deliver higher efficiency levels.

The Auditor-General’s report dated 2012 covered the financial and operational accounts of all public institutions in the country, from the period 2008 to 2012. However, what was captured for the NHIS spanned the period 2008 to 2009.

Mr Mensah disclosed that “there had never been a risk assessment of the scheme till late 2009” when he assumed office alluding to the fact that the first ever risk evaluation of the health insurance scheme was initiated by him in 2009.

Risk assessment is said to be critical and routine for any insurance scheme as it consists of an objective evaluation of inherent risks and hazards in the operations of an organization or business concern. It provides a focused basis for mitigating such risks through deliberate strategies.

According to Mr Mensah, though he was not at post in 2008 and a substantial part of 2009, he has had to respond to the Auditor-General’s report as Chief Executive because he has clear understanding of what transpired.

In a blow-by-blow response on Citi FM, he described the Auditor-General’s report as “competent, legitimate and a true reflection of what happened over the 2008/2009 period.”

According to him, many of the Auditor-General’s findings were informed by a comprehensive audit of the district schemes he initiated as a move to ensure transparency and accountability in the operation of the NHIS. “It is from our internal audit report that over 80 percent of the issues you find here were derived,” he stated.

On the claim that monies were diverted into a non-existent account, he explained that it was the Authority that uncovered the ploy to defraud the scheme through a targeted forensic audit of the health facility, leading to the arrest and prosecution of the then scheme manager and a hospital staff.

He maintained that after about five years of court trial, two officers were convicted to 5 years in prison each over their connivance with the then administrator of the Samatek Hospital in diverting GHC 131,409.26 paid to the facility by the NHIA. Judgment on this case was delivered four months ago.

On a point that the NHIA paid monies to some providers in 2008 even when their claims had not been vetted, Mr Mensah responded that though he was obviously not at the NHIA at the time, in his view and in practice, there was nothing wrong with the advance payment made to those facilities prior to the vetting of their claims.

According to the Chief Executive, the NHIA usually agreed to requests from some facilities in distress to make about 40 to 50 percent advance payment on the face value of their claims when there is obvious delay in the vetting to allow for essential payments such as salaries for the facility while vetting continued and the rest topped up after vetting was concluded.

He added that prior to his assumption of office, premiums were collected at the district level while the Authority further made funds transfer for claims payment at the district facilities. He said however that currently a centralized Consolidated Premium Account (CPA) has been established into which all premiums collected are deposited to make for improved accountability and financial efficiency at the scheme/district level. He also said the review of the NHIS law from Act 650 of 2003 to Act 852 in 2012 was intended to address the administrative and operational lapses deriving from the then enabling Act/ Law.

Mr Sylvester Mensah took over from Mr Ras Boateng on 15 June 2009 as Chief Executive of the NHIA. In the interview he also said a raft of efficiency gain measures have been instituted since he assumed office to ensure all potential loop holes arising from administrative and operational flaws were adequately addressed, a process which he maintained was on-going with significant efficiency gains.

He mentioned some of these measures as the establishment of Zonal Claims Processing Centres (CPS) in Accra, Kumasi, Cape Coast and Tamale to inject professional and competent pairs of hands in the claims management regime and quicken the vetting process, the introduction of the instant ID card to allow for efficient authentication and reduce subscriber abuse of the system, electronic claims processing to ensure efficiency, uniformity and speed in claims management, clinical audits and quality assurance to ensure value for money for health care delivery, capitation to reduce supply-side moral hazard and general financial efficiency, systems improvement, improved financial management arrangement for greater accountability, regular stakeholder engagements, and a host of other strategies and initiatives that has made Ghana’s NHIS a true global model for international learning and knowledge-sharing.

He urged for extreme caution to avoid sensationalism that only misinforms and negatively impacts on the high and increasing public confidence of subscribers of the scheme.