A special audit exercise undertaken by the
National Health Insurance Authority (NHIA), has found 10 national health
insurance scheme managers, accountants and five service providers in the
Ashanti Region culpable of misappropriating funds.
They have been interdicted and asked to report to the Ashanti Regional
Serious Fraud Office (SFO) in Kumasi for further investigations.
The schemes involved are Asokwa, Manhyia and Subin Sub-Metropolitan
Areas all within Kumasi Metropolitan Area, Sekyere East, Atwima Nwabiagya,
Asante Akim North, Asante Akim South, Offinso, Ejisu-Juaben and Afigya
Sekyere Districts.
The service providers are Yaw Opoku Mensah Chemical Shop, Western
Pharmacy and Saint Dominic Pharmacy, at Sekyere East District.
The rest are Apikrist Pharmacy and A.A Adams Pharmacy at Offinso
District.
Briefing the media in Accra on Friday, Mr Sylvester Mensah, Executive
Secretary of NHIA said though the culprits had been interdicted and being
investigated, "until SFO completes its investigations and submit the
findings; we cannot say they have embezzled funds".
Information available indicated that at the Asokwa Sub-Metropolitan
Scheme Office, the officials could not account for 569,104.02 Ghana cedis
being revenue for the payment of provider claims.
The accountant at Sekyere East District could not account for 66,121
Ghana cedis of premium and processing fees.
He however admitted the offence and refunded 10,000 Ghana cedis, while
the scheme manager misapplied 800,000 Ghana cedis meant for claims for other
purposes.
It was directed that the scheme should cease transacting business with
the following unaccredited providers: Yaw Opoku Mensah Chemical Shop,
Western Pharmacy and Saint Dominic Pharmacy.
At Atwima Nwabiagya District, the scheme overpaid four service
providers 7,544.30 Ghana cedis, and the scheme manager, accountant and
claims manager were directed to refund the money immediately.
At Asante Akim North District, the scheme manager misappropriated 7,650
Ghana cedis being premium and processing fees, and in addition transferred
25,906 Ghana cedis of claims monies for administrative purposes.
Findings at Asante Akim South District showed that the scheme could not
account for 3,393 Ghana cedis of premium collected and also transferred
44,320 Ghana cedis for administrative purposes.
At Offinso District the scheme transacted business with unaccredited
providers who did not submit claims, but were reimbursed for services
provided.
It was directed to cease any transaction with Apikrist and A.A Adams
Pharmacies.
At Ejisu Juaben District, the scheme could not account for 5,145 Ghana
cedis being premium collected and the scheme manager together with the
accountant were asked to refund the money.
On indiscriminate use of monies meant to pay claims for other purposes,
the report said Manhyia Sub-Metropolitan Scheme had acquired a building for
use as an office accommodation at a cost of 148,000, Ghana cedis and the
scheme manager was asked to step aside, while investigations continued.
It said the scheme manager at Afigya Sekyere District misapplied
133,351.87 Ghana cedis meant for claims for administrative purposes, and the
manager was asked to step aside while investigations continued.
At Subin Sub-Metropolitan Area, the scheme spent 23,702 Ghana cedis on
preliminary expenses towards the acquisition of a piece of land but it is
yet to acquire the land.
The report called on schemes to seek the approval of the NHIA before
transferring claims' monies for other purposes.