NHIS Strikes Against Fraudsters …As Doctor Bags 10 Years Jail Term For Defrauding Scheme

Francis Ametewee (L) and Dr N. K. Ametewee (R)

A former Medical Superintendent of the Essikado District Hospital, in the Western Region, Dr N. K. Ametewee was last week Thursday, jailed 10 years by the Sekondi High Court for defrauding the National Health Insurance Authority (NHIS) to the tune of four hundred and fifteen thousand Ghana cedis (GHC415, 000).

He was convicted and sentenced together with his accomplice and brother Francis Ametewee who served at the records department of Dr Ametewee’s private dental clinic in Anaji in Takoradi. Francis was given a 5-year jail sentence.

They were found guilty by the court presided over by Justice Edward Amoako Asante after the NHIA reported a case of fraud and forgery to the Criminal Investigations Department (CID) of the Ghana Police Service in 2014. The two were subsequently picked up by the Police in January 2015.

Dr Ametwee, a dental surgeon who headed the Essikado District Hospital was found to have submitted claims of about 500 NHIS card users whom he claimed had patronised the services of his private clinic, West Anaji Dental Clinic, in the Western Region.

He was exposed following a routine inspection by NHIA’s clinical audit team in 2014. The NHIA usually organised an audit after claims had been submitted by both private and public hospitals and clinics from all the 10 regions of the country.

It was during the period January to December 2013 that the audit team realised that Dr Ametewee had submitted the same names of NHIS card users for claims for the Essikado District Hospital and for his private clinic.

That meant that after the claims for the district hospital had been paid, Dr Ametewee, in a calculated attempt, systematically submitted the same names, after a few weeks, to the NHIA to be paid the same amount for his clinic. He did this with the help of his brother Francis, who worked as a record keeper at Dr Ametewee’s private facility.

Enquiries made by the audit team revealed that none of the names Dr Ametewee submitted for claims as NHIS card holders ever patronised his clinic for any ailment or condition.

Officials of the NHIA then made a report to the CID about fraud perpetrated by the medical officer which led to the doctor’s arrest.

The court, apart from the custodial sentences, has asked them to refund the said amount to the NHIA.

It was revealed that Dr. Ametewee offered a bribe of GH¢5,000 to the NHIA’s Director of a clinical audit team at the time to cover up his activities but the official rejected it. The GH¢5,000 ‘bribe’ had a note attached to it and read:

“Dear Doc, this is something small for your hard work. It is not a bribe. Take it and relax. In Ghana, everybody ‘chops’ from his work side. From your friend, Doctor Ametewee.”

The jailing of the two is hoped to deter others who may have similar intentions of milking the health insurance scheme to desist from entertaining such thoughts.

The development comes at a time when the National Health Insurance Scheme (NHIS) is reeling under heavy financial burdens that threatens its survival.

Many other service providers have devised ways of milking the NHIS dry as a result of such practices.

A clinical Audit conducted by the National Health Insurance Authority (NHIA) at the Dunkwa Government Hospital for instance revealed multiple instances of questionable claims made by the facility for the period between 2014 and 2016.

We need stiffer punishments for fraudsters

The CEO of NHIA, Dr. Samuel Annor in May 2018 called for a stronger legal framework that will enable the scheme to prosecute persons who defraud the system.

He said the scheme’s present legal framework limits the Authority from taking punitive measures against persons who defraud the system, and is not deterrent enough to prevent fraud.

Speaking at a stakeholders meeting with organized labour, the CEO said the Scheme expends most of its finances to pay huge claims, a significant amount of which contain errors and fraudulent claims thus weakening the financial standing of the Scheme.

He added that should the existing law be amended to ensure stiffer punishments for those who defraud the scheme, it will be a useful deterrent and will minimize the wastage.