A clinical and compliance audit sanctioned by the National Health Insurance Authority (NHIA) has directed the Akim Oda Government Hospital in the Eastern Region to refund GH¢312,413.51 after uncovering widespread irregularities in its operations and claims submissions.
The audit, commissioned by NHIA Chief Executive Dr Victor Asare Bampoe, followed a whistleblower’s allegations of fraudulent practices at the facility between February and May 2025. Conducted from July 14 to 18, 2025, the investigation involved a multidisciplinary team drawn from the NHIA’s Quality Assurance and Internal Audit directorates, the Claims Processing Centre (CPC) in Accra, and an external clinician.
The auditors reviewed claims submitted by the 162-bed government hospital, which is credentialed as a Public Primary Hospital (Catering Exclusive). Between January 2024 and April 2025, the hospital submitted 120,589 claims worth GH¢47.6 million.
The review, however, revealed numerous irregularities, including:
- Medicines billed but not dispensed
- Overbilling of pharmaceuticals
- Inappropriate prescribing practices, particularly involving antibiotics, opioids, and anticoagulants
- Application of catering-inclusive tariffs, despite the hospital’s catering-exclusive status
- Out-of-pocket charges to NHIS members for services covered by the scheme
The report concluded that these breaches inflated claims and placed an undue financial burden on patients.
In its directive, the NHIA ordered the facility to refund GH¢312,413.51 to the Authority and cease the practice of charging NHIS members out of pocket.
“The facility is hereby directed to refund GH¢312,413.51 to the NHIA for various breaches and irregularities identified in claims submitted,” the sanctioned report stated.
The audit team further recommended that all future claims from the hospital, starting May 2025, undergo strict validation before reimbursement.
Dr Bampoe stressed that the NHIA would not tolerate malpractices that undermine public trust in the National Health Insurance Scheme.
“The Authority will not tolerate breaches that undermine public confidence in the NHIS,” the report emphasised.
He highlighted that the government, under President John Dramani Mahama, has prioritised the elimination of financial barriers to healthcare as part of its drive toward achieving Universal Health Coverage (UHC).
Dr Bampoe added that the NHIA’s current debt-free status on claims payments, made possible by the uncapping of the National Health Insurance Levy (NHIL), underscores the government’s commitment to funding the scheme regularly and sustainably.
The Executive Management of the NHIA has pledged to intensify compliance and clinical audits across health facilities nationwide. These measures aim to:
- Protect the financial sustainability of the NHIS
- Ensure compliance with operational guidelines
- Guarantee that members enjoy full benefits without illegal charges
Since assuming office, Dr Bampoe has repeatedly emphasised accountability, transparency, and financial controls in the management of the NHIS. He has vowed to curb fraudulent claims and co-payments that exploit patients, noting that such practices are inconsistent with the Authority’s mandate.
“The funds must always be used for their intended purpose. Challenges such as co-payments and fraudulent claims must be eliminated at all costs,” he stressed.
The directive against Akim Oda Government Hospital marks one of the strongest enforcement actions under Dr Bampoe’s leadership and signals the NHIA’s renewed resolve to protect public funds and rebuild trust in the scheme.
By reinforcing compliance and oversight, the NHIA seeks to ensure that the NHIS remains financially sustainable, transparent, and reliable in delivering quality healthcare to Ghanaians.
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