The Bureau of National Investigations (BNI) is investigating how some health facilities were certified to become service providers of the National Health Insurance authority (NHIA).
This is in connection with the BNI’s investigations into allegations of false claims by some 10 medical facilities, with suspicions that the processes were compromised.
Earlier today [January, 1], the immediate past Chief Executive Officer of the NHIA, Sylvester Mensah, was invited for questioning by the BNI.
The security agency is also investigating how tariffs for providers are calculated, vetted and the components of the membership and financial management.
Below are some of the areas of interest to the BNI:
- The Accreditation/credentialing process: What processes a health facility goes through to become a service provider of the NHIA.
- Provider tariffs: How tariffs for providers are calculated and what tariffs apply to the various provider levels under the NHIS.
- Claims: How claims are vetted/processed. What ingredients go into claims vetting and how monies are paid to providers after claims vetting, operation of the NHIS Claims Processing Centres etc
- Membership and financial management
The BNI began investigations into the issue of false claims by some 10 suspected medical facilities which has already resulted in the arrest of five other officials at the NHIA headquarters with three of them being prepared for court to be remanded whilst the other two have been granted bail.
The BNI also picked up 17 directors and deputy directors of the Authority in connection with the matter.
Reports say investigations began six months ago at the instance of President John Mahama.
and according to the BNI, many of the medical facilities have been falsifying documents and submitting bloated claims to the NHIA and in some cases colluded with officials of the NHIA to defraud the Authority.
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By: citifmonline.com/Ghana