The National Health Insurance Authority (NHIA) has announced plans to establish an Anti-Fraud and Illegal Payments Directorate as part of efforts to detect and curb unauthorised out-of-pocket payments charged by healthcare providers under the National Health Insurance Scheme (NHIS).
The proposed directorate is expected to strengthen the Authority’s capacity to identify fraudulent practices, monitor illegal charges and address claims leakages that could undermine the sustainability and effectiveness of the national health insurance programme.
NHIA is also urging Parliament to prioritise amendments to the National Health Insurance Authority Act, 2012 (Act 852), to strengthen sanctions against individuals and institutions involved in fraud and illegal payments under the scheme.
NHIA’s Deputy Chief Executive Officer in charge of Operations, Dr Kwesi Djokoto, made the call during a visit by Parliament’s Health Committee to the Authority.
During the engagement, Dr Djokoto highlighted the need for legislative support to complement the NHIA’s existing digital systems and operational reforms aimed at improving claims processing, payments and the monitoring of service providers.
He said the Authority had invested in digital infrastructure to support its operations and was seeking to build on those interventions through stronger legislation and enforcement measures.
“We have super digital infrastructure in place that would support our operations, so the committee can help us prioritise the amendment of Act 852. The Ministry of Health is already working on it. It strengthens sanctions for fraud and illegal payments and supports capital budget funding for 2027.
“In summary, claims are electronic, with a 20-day turnaround time; we are paying monthly, and we have digital interventions to enhance the work of the National Health Insurance Authority.”
Dr Djokoto’s remarks underscore the NHIA’s position that technological improvements must be supported by an effective legal framework to deter misconduct and ensure compliance with the scheme’s rules.
The proposed Anti-Fraud and Illegal Payments Directorate is expected to play a key role in identifying irregularities in healthcare billing and claims submitted by facilities participating in the NHIS.
CNR