Health, News

Doctor jailed for NHIS fraud

A Sekondi High Court has sentenced a former medical superintendent of the Essikado District Hospital in Sekondi-Takoradi to 10 years’ imprisonment for fraud.

The convict, Dr N.K. Ametewee, who also operated a private dental clinic in the metropolis, was jailed last Thursday for defrauding the National Health Insurance Authority (NHIA) to the tune of GH¢415,000.

He was convicted and sentenced together with his accomplice and brother, Francis Ametewee, who worked at the records department at the doctor’s private dental clinic.

His accomplice was slapped with a five-year jail term.

The NHIA reported a case of fraud and forgery to the Criminal Investigations Department (CID) of the Ghana Police Service in 2014.

The two convicts were subsequently picked up by the police in January 2015.

Dr. Ametewee, a dental surgeon, who headed the Essikado District Hospital, was found to have submitted claims of about 500 National Health Insurance Scheme (NHIS) card users whom he claimed had patronised the services of his private clinic at West Anaji.

The former medical superintendent was exposed following a routine inspection by NHIA’s clinical audit team in 2014.

It emerged that 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.

Within the period from January to December 2013, 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.

It meant that after the claims for the district hospital had been paid, the doctor, 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.

According to the prosecutor, the convicted doctor carried out the diabolic plan with the help of his brother Francis, who worked as a record keeper at the 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 made a report to the CID about fraud perpetrated by the medical officer, which led to the doctor’s arrest.

After a protracted hearing, the two were found guilty by the court presided over by Justice Edward Amoako Asante.

The court, apart from the custodial sentences, also asked them to refund the said money to the NHIA.

The development comes at a time when the NHIS is reeling under heavy financial burdens that threaten its survival.

Doctor’s Bribe

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,” it was revealed.

It was also revealed that many other service providers had devised ways of milking the NHIS dry as a result of such practices.

“So 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.

NHIA Boss

The Chief Executive Officer (CEO) of NHIA, Dr. Samuel Annor, in May 2018 called for a strong legal framework that would enable the scheme to prosecute persons who defrauded the system.

He indicated that the scheme’s present legal framework prevents the Authority from taking punitive measures against persons who defraud the system.

Source: Daily Guide

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