Akim Oda Government Hospital to Cough ¢312k After NHIS Claims Inflation Expose
The Akim Oda Government Hospital has been directed to reimburse GH¢312,413.51 to the National Health Insurance Authority (NHIA) after it was exposed for various breaches and irregularities identified in claims submitted.
A Clinical and Compliance Audit report identified multiple discrepancies, including medicines billed to the Scheme but not dispensed, overbilling of pharmaceuticals, and inappropriate prescribing of antibiotics, opioids, and anticoagulants.
“The hospital also applied incorrect catering-inclusive tariffs and demanded out-of-pocket payments from NHIS members for services that should have been covered. As a result, the NHIA has recommended a refund of GHC312, 413.51 to the Authority and called for stricter validation of future claims.”
“The facility is hereby directed to refund GH¢312, 413.51 to the NHIA for various breaches and irregularities identified in claims submitted.”
The audit covered claims amounting to GH¢47,645,535.00 submitted to the Authority over a 16-month period from January 2024 to April 2025.
The report stated, “There were variances in the quantities of medicines dispensed in the facility’s system and those submitted to NHIA for reimbursement.”
It further noted that “members of the scheme make out-of-pocket payments for some services and medicines covered by the scheme,” a direct violation of NHIS policy.
About Audit
The audit, sanctioned by NHIA Chief Executive Dr. Victor Asare Bampoe, followed alleged fraudulent practices at the facility.
The multidisciplinary audit team, comprising personnel from NHIA’s Quality Assurance and Internal Audit directorates, Claims Processing Centre (CPC) Accra, and an external clinician, conducted the investigation from July 14 to 18, 2025.
Their mandate was to validate claims submitted by the hospital and assess the actual services rendered to National Health Insurance Scheme (NHIS) members.
Source: https://opemsuo.com/author/hajara-fuseini/
