THE managements of the County Hospital at Abrepo and the Atasemanso Hospital, all in Kumasi, are strictly observing a directive by the National Health Insurance Authority (NHIA) suspending them from providing any medical care to members of the National Health Insurance Scheme.
However, according to the management of the Atasemanso Hospital, even though they were complying, they were unhappy with the manner in which the NHIA had handled the issue without giving them the opportunity to respond to “what was perceived as adverse findings against them”..
They claim they have been treated unfairly by the NHIA by not giving them the opportunity to respond to the findings, and chose to go public with the allegations and consequent decision to suspend them.
The management of the hospital told the Daily Graphic they had no choice but to comply with the suspension order but were planning to seek further audience with the NHIA to iron out the issues.
Patients registered under the insurance scheme are politely turned away from the records department of the two suspended hospitals in Kumasi, which are the first point of call, with an excuse that “we have problems with the scheme authorities and not until the problems are sorted out, we cannot provide you with any medical care ”.
Patients who seek further explanations on the nature of problems hit a blank wall because apart from describing the problem as personal, no further explanations are given to them.
Ms Gift Twum Antwi of the Records Department of County Hospital who attended to curious card holders of the scheme, however, hinted that “by the end of November, we would have sorted things out and began providing medical care to members under the insurance scheme”.
The Medical Director of the County Hospital was, however, not in the office to comment on the issue, and other medical personnel were tight-lipped when patients probed.
“We were suspended by the NHIA about two weeks ago on issues which I cannot explain”, Ms Twum Antwi hinted.
The two private hospitals in Kumasi- County and Atasemanso- were suspended by the NHIA for three months, beginning August 14 to November 13, 2009 for allegedly “indulging in fraudulent activities, including double billing, over billing and irrational prescriptions”.
According to a Daily Graphic report on August 19, 2009, “the action of the authorities was based on the results of investigations carried out by its clinical audit team between March 23 and March 27, 2009.”
The report further stated that “the two hospitals have appealed against the NHIA’s decision but a review by health care professionals upheld the findings and decision of the NHIA”.
The report also quoted the acting Chief Executive Officer of the NHIA, Mr Sylvester Mensah, as saying that apart from the overbilling, double billing, irrational prescription and non-adherence to tariffs, the hospital also provided poor quality care and unsupported claims and also engaged in fraud, leading to their suspension.
Responding to the matter, Dr John Boateng, the Medical Director of the Atasemanso Hospital, told the Daily Graphic that he preferred not to respond to the issues in the media but rather through direct correspondence with the NHIA.
Nonetheless he said the allegations against the hospital were incorrect and besides it was not given the fair opportunity to respond.
He said in the first place the hospital was not a primary level care centre as was alleged by the NHIA since it also attended to referred cases from other hospitals.
He said the NHIA took samples of folders of patients from the hospital and after studying them, decided to suspend them without allowing them to respond to perceived adverse findings in the folders.
He said the management of the hospital, in any case, had no choice but to comply with the suspension order but was greatly worried about the unfair treatment.
He said there was never any case of malice on the part of the hospital to deliberately sabotage the health insurance scheme, and expressed the hope that the decision to suspend the hospital’s accreditation would be rescinded to enable it to continue offering services.
Dr Boateng said the hospital handled more chronic diseases as depicted by its monthly report sent to the Ministry of Health.
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