Doctor defrauds NHIA and Ghana to the tune of GH¢415,000...

Two persons, one of whom is the Medical Superintendent of the Essikado District Hospital in the Western Region, Dr N.K. Ametewee, have been arrested for allegedly defrauding the National Health Insurance Authority (NHIA) to the tune of GH¢415,439.15.

Dr Ametewee, who is a dental surgeon, offered a bribe of GH¢5,000 to the director of a clinical audit team of the NHIA to cover up the deal, but the official refused it.

A cover note he added to the cheque, which is available to the Daily Graphic, stated: "Dear Doc, this is something small for your hard work. It is not a bribe. Take it and relax. In Ghana, everybody 'chops' from his work side. From your friend, Doctor Ametewee."

He is alleged to have submitted claims of about 100 NHIS card users whom he claimed had patronised the services of his private clinic, West Anaji Dental Clinic, in the Western Region.

The doctor was arrested together with his younger brother, Francis Ametewee, by the Criminal Investigations Department (CID) of the Ghana Police Service on Tuesday.

The suspects are currently in police custody for fraud and bribery and will soon be processed for court.

Arrest of suspects

Briefing the Daily Graphic in Accra yesterday, the Head of the Fraud Unit at the CID Headquarters, Chief Superintendent Mr Felix Koku Mawusi, said officials of the NHIA made a report to the CID about fraud perpetrated by a medical officer in the Western Region, which led to the doctor's arrest.

He explained that the clinical audit team of the NHIA usually organised an audit after claims had been submitted by both private and public hospitals and clinics from all the 10 regions of the country.

It was during the period January to December 2013 that the audit team realised that Dr Ametewee had submitted the same names of NHIS card users for claims for the Essikado District Hospital and for his private clinic.

That meant that after the claims for the government hospital had been paid, Dr Ametewee, in a calculated attempt, systematically submitted the same names, after a few weeks, to the NHIA to be paid the same amount for his clinic.

Enquiries made by the audit team has so far revealed that none of the names Dr Ametewee submitted for claims as NHIS card holders ever patronised his clinic for any ailment or condition.

Francis's arrest

According to Chief Supt Mawusi, Francis, who claimed to be a record keeper at the clinic, was arrested for assisting his brother in the fraud.

"During our investigations, we found out that Francis had entered the names of some people in the claims record at the behest of his brother. We then had to arrest him to assist us in our investigations.

"For now, investigations are still underway and we will ensure that we inquire from all the names he used to make the claims for his clinic. We hope to unravel more as we continue with the rest of the investigations," he said.