NHIA urges Parliament to amend Act 852 for anti-fraud directorate

The National Health Insurance Authority (NHIA) has called on Parliament to amend the National Health Insurance Act, 2012 (Act 852) to establish a new Anti-Fraud and Illegal Payments Directorate. During a meeting with Parliament’s Health Committee, Dr. Kwesi Djokoto, the NHIA’s Deputy Chief Executive Officer in charge of Operations, explained that the legislative update is necessary to curb unauthorized out-of-pocket charges imposed by some healthcare providers. While the authority has integrated digital tools to improve efficiency, officials argue that a stronger legal framework is required to ensure financial transparency and the sustainability of the health insurance scheme.

The proposed Anti-Fraud and Illegal Payments Directorate would focus on detecting irregularities in billing and claims submissions from participating facilities. By formalizing this body under the amended Act, the NHIA aims to implement more rigorous sanctions that act as a deterrent against fraudulent activities. Dr. Djokoto noted that technological improvements in claims processing provide the necessary data infrastructure, but clear legal mandates are essential to hold providers accountable and protect subscribers from being forced to pay for services already covered by the scheme.

Beyond fraud prevention, the requested amendments seek to align the NHIA’s operational framework with the government’s Free Primary Healthcare initiative. Launched by President John Mahama on April 15, 2026, the program provides essential medical services at no cost at points of use, including community pharmacies and mobile kiosks. The authority stated that the legislative reforms would allow for the proper management of population-based payment systems and the electronic processing needed to scale these services across the country.

The NHIA maintains that these legal adjustments are critical for maintaining public trust and ensuring that health resources reach those in need. By combining modernized laws with its digital transformation, the authority intends to reduce waste and streamline service delivery for all National Health Insurance Scheme beneficiaries. The engagement with the legislative committee represents a significant step toward securing the necessary oversight tools to protect the integrity of Ghana’s healthcare financing system.