NHIA orders Akim Oda Hospital to refund GH¢312,413 over fraudulent claims
The National Health Insurance Authority (NHIA) has directed the Akim Oda Government Hospital in the Eastern Region to refund GHS312,413.51 following an audit that uncovered widespread malpractices in the facility’s operations and claims submissions.
The Clinical and Compliance Audit, sanctioned by NHIA Chief Executive Dr Victor Asare Bampoe, was prompted by a whistleblower report alleging fraudulent practices at the hospital between February and May 2025.
Conducted from 14 to 18 July 2025, the investigation involved personnel from NHIA’s Quality Assurance and Internal Audit directorates, the Claims Processing Centre (CPC) in Accra, and an external clinician.
According to the sanctioned report, the audit team was tasked with validating claims submitted by the hospital and assessing the actual services rendered to members of the National Health Insurance Scheme (NHIS). Their findings revealed several irregularities.
These included: Discrepancies between medicines dispensed and those billed to the NHIA; Overbilling of certain pharmaceuticals; Inappropriate prescribing practices involving antibiotics, opioids, and anticoagulants and Misapplication of catering-inclusive tariffs, despite the hospital being credentialed as a Public Primary Hospital (Catering Exclusive), leading to inflated claims
The report further uncovered instances where NHIS members were compelled to make out-of-pocket payments for services and medicines that should have been fully covered under the Scheme.
“The facility is hereby directed to refund GH¢312,413.51 to the NHIA for various breaches and irregularities identified in claims submitted. The Authority will not tolerate breaches that undermine public confidence in the National Health Insurance Scheme (NHIS),” the report stated.
The audit also instructed the hospital to cease demanding out-of-pocket payments from active NHIS members for covered services.
“Subsequent claims, starting from May 2025, should be thoroughly validated before reimbursement,” the report directed.
The Akim Oda Government Hospital, a 162-bed facility, had submitted a total of 120,589 claims amounting to GHS47.6 million between January 2024 and April 2025. However, the audit revealed significant variances.
“There were discrepancies in the quantities of medicines dispensed in the facility’s system and those submitted to NHIA for reimbursement,” the report highlighted.
It further noted that patients were charged out-of-pocket for medicines and services already covered by the Scheme, a clear violation of NHIS policy.
Dr Bampoe emphasised that the audit was conducted in accordance with Sections 31(1) and 35(2) of the National Health Insurance Act (Act 852), which mandate oversight to protect the Scheme’s integrity.
The NHIA has pledged to intensify monitoring to prevent future irregularities, stressing that strict enforcement is necessary to maintain public trust.
“The audit identified non-compliance with regulations and directives. Appropriate recommendations have been made to improve the NHIS and to ensure the financial sustainability of the Scheme,” the report added.
