[ 2014-10-01 ]

Auditor-General’s Findings Pre-Dated My Appointment—NHIA Chief
Chief Executive of the National Health Insurance
Authority (NHIA), Sylvester A. Mensah, has
revealed that findings in the just released
Auditor-General’s report largely pre-dated his
tenure as Chief Executive of the NHIA. He said he
inherited an NHIS that was fraught with a lot of
operational and administrative inefficiencies. Mr
Mensah made the comment while responding to the
2012 Auditor-General’s report which covered the
2008 and 2009 operations of the NHIS on Citi FM on
Tuesday.

According to him, “the scheme under the NDC
regime has seen tremendous growth in all its key
performance indicators.” And that the NHIS has
since experienced radical reforms making the
scheme today significantly different with improved
systems, structures, and strategies that deliver
higher efficiency levels.

The Auditor-General’s report dated 2012 covered
the financial and operational accounts of all
public institutions in the country, from the
period 2008 to 2012. However, what was captured
for the NHIS spanned the period 2008 to 2009.

Mr Mensah disclosed that “there had never been a
risk assessment of the scheme till late 2009”
when he assumed office alluding to the fact that
the first ever risk evaluation of the health
insurance scheme was initiated by him in 2009.
Risk assessment is said to be critical and routine
for any insurance scheme as it consists of an
objective evaluation of inherent risks and hazards
in the operations of an organization or business
concern. It provides a focused basis for
mitigating such risks through deliberate
strategies.

According to Mr Mensah, though he was not at post
in 2008 and a substantial part of 2009, he has had
to respond to the Auditor-General’s report as
Chief Executive because he has clear understanding
of what transpired.

In a blow-by-blow response on Citi FM, he
described the Auditor-General’s report as
“competent, legitimate and a true reflection of
what happened over the 2008/2009 period.”
According to him, many of the Auditor-General’s
findings were informed by a comprehensive audit of
the district schemes he initiated as a move to
ensure transparency and accountability in the
operation of the NHIS. “It is from our internal
audit report that over 80 percent of the issues
you find here were derived,” he stated.

On the claim that monies were diverted into a
non-existent account, he explained that it was the
Authority that uncovered the ploy to defraud the
scheme through a targeted forensic audit of the
health facility, leading to the arrest and
prosecution of the then scheme manager and a
hospital staff. He maintained that after about
five years of court trial, two officers were
convicted to 5 years in prison each over their
connivance with the then administrator of the
Samatek Hospital in diverting GHC 131,409.26 paid
to the facility by the NHIA. Judgment on this case
was delivered four months ago.

On a point that the NHIA paid monies to some
providers in 2008 even when their claims had not
been vetted, Mr Mensah responded that though he
was obviously not at the NHIA at the time, in his
view and in practice, there was nothing wrong with
the advance payment made to those facilities prior
to the vetting of their claims. According to the
Chief Executive, the NHIA usually agreed to
requests from some facilities in distress to make
about 40 to 50 percent advance payment on the face
value of their claims when there is obvious delay
in the vetting to allow for essential payments
such as salaries for the facility while vetting
continued and the rest topped up after vetting was
concluded.

He added that prior to his assumption of office,
premiums were collected at the district level
while the Authority further made funds transfer
for claims payment at the district facilities. He
said however that currently a centralized
Consolidated Premium Account (CPA) has been
established into which all premiums collected are
deposited to make for improved accountability and
financial efficiency at the scheme/district level.
He also said the review of the NHIS law from Act
650 of 2003 to Act 852 in 2012 was intended to
address the administrative and operational lapses
deriving from the then enabling Act/ Law.

Mr Sylvester Mensah took over from Mr Ras Boateng
on 15 June 2009 as Chief Executive of the NHIA. In
the interview he also said a raft of efficiency
gain measures have been instituted since he
assumed office to ensure all potential loop holes
arising from administrative and operational flaws
were adequately addressed, a process which he
maintained was on-going with significant
efficiency gains.

He mentioned some of these measures as the
establishment of Zonal Claims Processing Centres
(CPS) in Accra, Kumasi, Cape Coast and Tamale to
inject professional and competent pairs of hands
in the claims management regime and quicken the
vetting process, the introduction of the instant
ID card to allow for efficient authentication and
reduce subscriber abuse of the system, electronic
claims processing to ensure efficiency, uniformity
and speed in claims management, clinical audits
and quality assurance to ensure value for money
for health care delivery, capitation to reduce
supply-side moral hazard and general financial
efficiency, systems improvement, improved
financial management arrangement for greater
accountability, regular stakeholder engagements,
and a host of other strategies and initiatives
that has made Ghana’s NHIS a true global model
for international learning and knowledge-sharing.

He urged for extreme caution to avoid
sensationalism that only misinforms and negatively
impacts on the high and increasing public
confidence of subscribers of the scheme.

Source - ModernGhana

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