NHIA to rollout biometric verification of patients to eliminate fraud, says Oko Boye

The chief executive of the National Health Insurance Authority (NHIA) Dr Bernard Okoe Boye has disclosed that the authority, will from next year (2023), begin biometric verification of all patients who visit hospitals to seek healthcare with their National Health Insurance card.

The new policy, according to Dr Okoe Boye, will help the National Health Insurance Authority to put a stop to underserved payments made to hospitals who make claims when they have not offered the services for which they are demanding payments.

Speaking at the Jubilee House on Friday 9 December 2022, when the board of directors and the management of the NHIA, paid a courtesy call on President Akufo-Addo, to brief him on recent developments at the Authority, Dr Okoe Boye, said the rollout of the biometric verification will cut out the phenomenon of fraudulent claims that the Authority has had to deal with.

“Next year we are going to have biometric verification. For these 19 years that we have been running the insurance, all the claims we pay, we pay in the dark in quotes, because hospitals give us documents that these people came to see us, we have no real time evidence that they were actually there, and we have had cases that have been prosecuted in court where claims were fraudulently generated,” Dr Okoe Boye said.

“Starting next year, we are going to, again, with the National Identification Authority (NIA) system, every Ghanaian, (it will be faced), when you go to the hospital, you will be biometrically verified before you are seen so that before the month ends, I know that Komfo Anokye saw to 5,000 patients. They [hospitals] can’t send me [NHIA] bills of 6000 people. That alone will cut out the fraud in the system,” the NHIA CEO stated.

Accessibility

The NHIA currently has about 17 million Ghanaians enrolled on it, according to Dr Okoe Boye. Out of this number, the NHIA boss indicated that about 1 million visit various hospitals annually throughout the country.

By the end of the 2022, Dr Okoe Boye, said the service is targeting to register about 18.3 million Ghanaians and that will represent a total of 57% of all Ghanaians.

Dr Okoe Boye, further indicated that the immediate objective of the Authority is to improve the user friendliness of the scheme across the length and breadth of the country.

“Under your [President Akufo-Addo] leadership, in December 2018, we introduced the short code, *929#, which allows you to renew your membership without necessarily having to drive your vehicle to our office” Okoe Boye said.

“And out of the 17 million Ghanaians who are on the scheme now, 13 million, about 80%, renewed through *929#. Mr President, this tells us the convenience that it has brought and the savings, because, all this people would have had to leave their houses, go and queue in our offices and all that, so it is a very significant achievement” he added.

Claims

Commenting on claims management by the NHIA, Dr Okoe Boye, observed that the Authority has been working hard to fulfil a campaign promise made by President Akufo-Addo, to transform the manual management of NHIS claims to an electronic system.

“Your Excellency you told Ghanaians that [the NHIA claims management which was 10% electronic and 90% manual, you will turn it around and make it 90% electronic and 10% manual].

“I am happy to say that it was a 10% electronic system [and] within this time, we have gotten to 70% electronic management of the claims. And we are on course to get to 100% by the first half of next year (2023).

“Manual management of claims will be a thing of the past. Mr. President, this is very significant because 70% of all the monies that come to the fund are used in paying claims” Dr Okoe Boye said.

“If 70% of your fund is for paying claims, and you don’t have a very efficient system, it means that the wastage will be very huge, and I am happy to say that by first half of next year, latest by June next year, the story of manual claims management will be a thing of the past” he added.

Commendation

President Akufo-Addo in response to the brief by the NHIA boss, commended the staff, management and board of directors for their transformative agenda at the Authority.

The President further pointed out that, he considers the decision to introduce biometric verification of NHIS users at all hospitals a brilliant idea. He urged the NHIA delegation to go all out and implement the new measure.

“I think the biometric verification of patients is also another very important step in trying to give some rigor to the scheme so that as much as possible, claims [are] verifiable and in real time not that you have to wait for hours for audits, etc. All of these are very important” President Akufo-Addo said.

“So, all I can say is, to all of you, from the chairman, through you, the chief executive and members of the board the deputies, is to congratulate you on the work that you are doing on behalf of our country. It is important that government and the society in general, mobilizes as much as possible, to support the work that you’re doing” Akufo-Addo added.

The NHIA

The National Health Insurance Authority (NHIA) was established under the National Health Insurance Act 2003, Act 650, as a body corporate, with perpetual succession, an Official Seal, that may sue and be sued in its own name.

As a body corporate, the Authority in the performance of its functions may acquire and hold movable and immovable property and may enter into a contract or any other transaction.

A new law, Act 852, replaced ACT 650 in October 2012 to consolidate the NHIS, remove administrative bottlenecks, introduce transparency, reduce opportunities for corruption and gaming of the system, and make for more effective governance of the schemes.

The object of the Authority is to attain universal health insurance coverage in relation to persons’ resident in the country, persons not resident in the country but who are on a visit to this country and to provide access to healthcare services to the persons covered by the Scheme.

The Vision of the NHIA is to be a model of a sustainable, progressive and equitable national health insurance scheme in Africa and beyond in order to provide financial risk protection against the cost of quality health care for all residents in Ghana.

Delighting its members and other stakeholders with an enthusiastic, motivated and empathetic professional staff who share the values of honesty and accountability in partnership with all stakeholders constitutes the mission of the Authority.