The National Health Insurance Authority (NHIA) announced plans to establish an Anti‑Fraud and Illegal Payments Directorate aimed at detecting and curbing unauthorized out‑of‑pocket payments made by healthcare providers under the National Health Insurance Scheme (NHIS).
Dr Kwesi Djokoto, NHIA’s Deputy Chief Executive Officer in charge of Operations, said the new directorate would enhance the Authority’s capacity to identify fraudulent practices, monitor illegal charges and address claims leakages that threaten the sustainability of the national health insurance programme.
During a visit by Parliament’s Health Committee, Dr Djokoto urged lawmakers to prioritise amendments to the National Health Insurance Authority Act, 2012 (Act 852) to strengthen sanctions against individuals and institutions involved in fraud and illegal payments under the scheme.
He highlighted that NHIA has already invested in digital infrastructure to support its operations, and that the proposed directorate would build on those interventions through stronger legislation and enforcement measures.
“We have super digital infrastructure in place that would support our operations, so the committee can help us prioritise the amendment of Act 852. The Ministry of Health is already working on it. It is strengthening sanctions for fraud and illegal payments and supporting capital budget funding for the year 2027,” Dr Djokoto said.
He added that claims are electronic with a 20‑day turnaround time, monthly payments are made, and digital interventions are in place to enhance the work of the NHIA.
The directorate is expected to play a key role in identifying irregularities in healthcare billing and claims submitted by facilities participating in the NHIS, with the ultimate goal of ensuring compliance with the scheme’s rules.
Moving forward, the NHIA will seek legislative support to complement its existing digital systems and operational reforms, aiming to deter misconduct and safeguard the integrity of the national health insurance programme.
