BNI detains Sylvester Mensah for questioning over false health insurance claims.

The Bureau of National Investigations has detained the former Chief Executive of the National Health Insurance Authority, Sylvester Mensah, for interrogation falsified and bloated health insurance claims.

Mr Mensah presented himself to officials of the BNI early Friday morning after some armed operatives stormed his residence in Accra the previous day, apparently to cause his arrest. He was however not at home at the time.

The BNI is investigating some workers of the Authority as well as owners and medical directors of more than 10 health facilities across the country over falsification of documentations of health insurance claims.

Some workers of the Authority are said to have colluded with the owners and directors of these health institutions in the fictitious and bloated deal.

TV3 sources within the NHIA say workers have been fully cooperative in the investigation as always and that on-going process will only produce an outcome that will improve the operations of the scheme.

Five workers of the Authority have so far been arrested in the ongoing investigation for their alleged complicity in the illegal deals and two of them have been granted bail.

Additional 17 persons have been cautioned and granted bail.

The investigations, which started six months ago, was at the instance of President John Mahama, after it emerged that some health owners and directors in collusion with the some workers of the Authority, were presenting bloated claims for payment.

TV3 gathered there have been intensified interactions between the NHIA and BNI within the past few weeks, with various NHIA directors and managers briefing the BNI on their roles, targets and work processes.

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Some healthcare providers have also been visited by BNI operatives and their books gone into respect of how claims from the service providers are processed before they submission to the NHIA for vetting.

Of particular interest are:

1. The Accreditation/credentialing process: What processes a health facility goes through to become a service provider of the NHIA.

2. Provider tariffs: How tariffs for providers are calculated and what tariffs apply to the various provider levels under the NHIS.

3. Claims: How claims are vetted/processed. What ingredients go into claims vetting and how monies are paid to providers after claims vetting, operation of the NHIS Claims Processing Centres among others

4. The 11-year journey of the NHIS, its achievements, challenges and way forward.

5. Membership and financial management

By Stephen Kwabena Effah|

Twitter @steviekgh