Doctor and accomplice jailed 15 years for defrauding NHIS

BY: Graphic.com.gh

A former Medical Superintendent of the Essikado District Hospital, in the Western Region, Dr N. K. Ametewee was on Thursday jailed 10 years by the Sekondi High Court for defrauding the National Health Insurance Authority (NHIS) to the tune of GH¢415,000.

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.

The court heard that Dr. Ametewe and his accomplice duplicated claims submitted by the dental unit of the Essikado District Hospital and resubmitted same for his private clinic at West Anaji Dental Clinic for payment.

In a calculated attempt, they were said to have systematically submitted the same names to the NHIA for payment to both the District Hospital and the private Clinic.

Enquiries however made by the NHIA Audit team revealed that none of the names, Dr. Ametewe submitted for claims as NHIS card holders ever patronised his clinic for any ailment or condition.

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Dr Ametewee, 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 at West Anaji Dental Clinic, in the Western Region.

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

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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.

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.

The Sekondi High Court presided over by Justice Edward Amoako Asante found them guilty and apart from the custodial sentences, the court 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 clinical audit team at the time to cover up his activities but the officials rejected it.

The court heard that 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.”

Reacting the sentencing, the NHIA expressed the hope that the jailing of the two will 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 that the management of the NHIA led by its CEO Dr. Samuel Annor is canvassing for extra funding to sustain the scheme.

Part of NHIA’s new reform agenda includes amending the law to make crime against the scheme more punitive to act as a deterrent to potential fraudsters of the scheme and also to fully implement electronic claims management which would improve efficiency and reduce fraud.

Again, the management of NHIA is working to improve Compliance (Clinical & Internal Audits) as well as to re-design the financial model of the scheme.