By Doreen Andoh
Akim Oda, Eastern Region — The National Health Insurance Authority (NHIA) has directed Akim Oda Government Hospital to refund GH¢312,413.51 following a Clinical and Compliance Audit that uncovered irregularities in claims and service delivery.
The audit, authorized by NHIA CEO Dr. Victor Asare Bampoe after a whistleblower complaint about suspected fraud between February and May 2025, was carried out by a multidisciplinary team from July 14–18, 2025. Inspectors validated claims and examined services rendered to NHIS members.
Major findings included medicines billed but not dispensed, overbilling of pharmaceuticals, inappropriate prescribing of antibiotics, opioids and anticoagulants, and the wrongful application of catering-inclusive tariffs despite the hospital’s “catering exclusive” credential. The report also found that members were asked to pay out-of-pocket for services covered by the Scheme.
The hospital submitted 120,589 claims valued at GH¢47,645,535 between January 2024 and April 2025. The NHIA has ordered repayment of the identified GH¢312,413.51 and instructed the facility to stop charging insured clients for covered services. The Authority also demanded stricter validation of claims, beginning with claims from May 2025.
“The Authority will not tolerate breaches that undermine public confidence in the National Health Insurance Scheme,” the sanctioned report states, noting the audit’s role in protecting the Scheme’s financial sustainability and ensuring quality care.
Dr. Bampoe reiterated his commitment to stronger financial controls, transparency and eliminating illegal co-payments, linking the effort to the government’s push for Universal Health Coverage. He highlighted the recent debt-free status on claims—attributed to timely government funding and the uncapping of the National Health Insurance Levy—as a reason public funds must be safeguarded and used appropriately.
The NHIA said it will continue nationwide clinical and compliance audits to ensure members receive their full entitlements and to curb fraudulent claims.
