After a failed attempt by the Bureau of National Investigations to arrest the former Chief Executive of the National Health Insurance Authority (NHIA) Sylvester Mensah, Peacefmonline.com gathers both parties have met amicably to resolve the issue at stake.
Issues of false claims by some ten suspected medical facilities, has pushed the BNI to commence investigations into the matter.
The findings has resulted in the arrest of some five officials at the NHIA headquarters but Peacefmonline.com understands there have been intensified interactions between the NHIA and BNI within the past few weeks, with various NHIA directors and managers briefing the BNI on their roles, targets and work processes.
Aside the interactions, some healthcare providers have had visits from the BNI to allow them look into their books in respect of how claims from the provider end are processed before they are submitted to the NHIA for vetting.
The NHIA has a mandate to run the NHIS by providing financial risk protection against the cost of basic healthcare for all residents in Ghana. In doing so, its work is subject to the work of other state institutions such as the auditor general and investigative bodies.
In an interaction with an official at the NHIA, he noted that “the ongoing process, the NHIA believes will only produce an outcome that will improve the operations of the scheme”.
Areas of interest to them have been:
1. The Accreditation/credentialing process: What processes a health facility goes through to become a service provider of the NHIA.
2. Provider tariffs: How tariffs for providers are calculated and what tariffs apply to the various provider levels under the NHIS.
3. 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
4. 11 year journey of the NHIS, its achievements, challenges and way forward.
5. Membership and financial management
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