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The 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 a clinical and compliance audit uncovered widespread irregularities in its claims submissions.
The audit, commissioned by NHIA Chief Executive Dr Victor Asare Bampoe, followed a whistleblower report alleging fraudulent practices at the facility between February and May 2025. A multidisciplinary team—comprising NHIA’s Quality Assurance and Internal Audit units, the Claims Processing Centre in Accra, and an external clinician—conducted the investigation from July 14 to 18, 2025.
The review revealed several malpractices, including:
Overbilling and misclassification of tariffs (catering-inclusive instead of catering-exclusive).
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Discrepancies in prescribed medicines, with drugs billed but not dispensed.
Inappropriate use of antibiotics, opioids, and anticoagulants.
Illegal out-of-pocket charges demanded from NHIS members for services covered under the scheme.
As a result, the NHIA directed the facility to refund the overpaid amount and warned against further breaches.
The report stated.
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The Authority will not tolerate practices that undermine public confidence in the National Health Insurance Scheme (NHIS)
Between January 2024 and April 2025, the 162-bed facility submitted 120,589 claims worth GH¢47.6 million. However, the audit identified inflated claims, inappropriate billing practices, and non-compliance with NHIA regulations.
The report further instructed that all claims from May 2025 onwards be subjected to stricter validation before reimbursement.
The NHIA emphasised that this audit is part of broader reforms to strengthen financial accountability, prevent fraud, and safeguard the sustainability of the scheme. Dr Bampoe reiterated his administration’s commitment to transparency, financial discipline, and eliminating illegal co-payments.
He noted that the government’s timely release of funds and the uncapping of the National Health Insurance Levy (NHIL) have positioned the NHIA in a debt-free status on claims, stressing that such funds must always be used responsibly.
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The Authority pledged to continue conducting compliance audits nationwide to protect NHIS members from exploitation and ensure quality healthcare delivery.