MEN 'DELIVERING' BABIES UNDER NHIS (MIRROR, PAGE 34, JULY 12, 2010)

From Moses Dotsey Aklorbortu,
Takoradi

Men are ‘delivering’ babies under the National Health Insurance Scheme (NHIS) as clinical audit of the scheme has uncovered new ways that some people have adopted to defraud the system at accredited public and private hospitals.
Financial claims by women, who, under the Free Maternal Care (FMC), had spontaneous vaginal delivery at the accredited hospitals across the country, were fraudulently classified under caesarian delivery which attracted higher premium.
The names of those who made the claims were then submitted and the claims running into millions of Ghana cedis were paid accordingly. But the NHIS has vowed to recover each pesewa that had been lost through the bogus claims.
Mr Sylvester Mensah, Chief Executive of the scheme, who announced this, said the scheme would not relent in its efforts to clear the system of people whose focus had noticeably been to sabotage the efforts of providing affordable health care to the people of Ghana.
He explained that some of the bills submitted in the name of women, who had been delivered of babies were questionable. The auditors therefore decided to cross-check the claims and discovered the fraud.
Mr Mensah said it was shocking to realise that many of the people whose names were given as women, who had been delivered under the FMC were actually men and not women.
That aside, he said some of the ‘women’, the service providers claimed had been delivered of babies were dead many years ago and were never in the hospitals for delivery or anywhere near the maternity block.
Again, “the women, who the service providers claim were delivered through caesarian section actually had spontaneous vaginal delivery. The women raised their dresses to show that there was no cut on their bodies,” he said.
Asked how men’s names were substituted for women, he said the names were generated from the computers without even looking to see if the names could be those of men.
He said from the month of July, the scheme would no longer run individual accounts for schemes, but a consolidated account with Ghana Commercial Bank (GCB) and the Agricultural Development Banks (ADB) for the various schemes to operate with unique codes.
This, he said, was to avert unwarranted payments that could run the scheme down.
Mr Mensah also said the scheme would also look at disaccrediting some private members of the service providers who referred card holders to their own clinics.
He explained that some doctors referred patients to privately owned clinics thereby billing the scheme twice.
“Instead of attending to the patients with the scheme, these medical doctors who have their facilities registered under the scheme refer their patients to their facilities,” he said.
“They will be billed by the hospitals they first visited and the second facility with the same sickness making it double billing,” he said.
The chief executive said with the engagement of the clinical audits system, huge amounts unduly siphoned from the scheme had been recovered.
“Also more than 35 scheme managers and officers had been interdicted, about four of the officers are in police custody charged for fraud,” he said.
He urged officers to avoid spreading negative things about the one-time payment and work for the success of scheme.