NHIA Central Regional Director Warns Health Facilities: Stop Charging Unlawful Fees Under NHIS in Ghana

In Ghana’s push for equitable healthcare, the National Health Insurance Authority (NHIA) plays a pivotal role. Recent directives from the NHIA Central Regional Director highlight a critical issue: unauthorized fees imposed by National Health Insurance Scheme (NHIS) providers. This guide breaks down the warning, its context, and actionable steps for subscribers and facilities to ensure compliance and access to affordable care.

Introduction

The National Health Insurance Scheme (NHIS) in Ghana aims to provide universal health coverage by making healthcare accessible without financial barriers for enrolled subscribers. However, unauthorized or unlawful charges by credentialed providers undermine this goal. On November 29, 2025, at a stakeholder meeting in Dunkwa-on-Offin, Upper Denkyira East Municipality, NHIA Central Regional Director Kojo Sekyere Koi Thompson issued a strong caution to all NHIS-accredited health facilities in the Central Region.

Event Context: Stakeholder Meeting on Universal Health Coverage

The meeting, themed “Attaining Universal Health Coverage: A Collective Responsibility,” brought together providers, district managers, and stakeholders. Director Thompson emphasized that imposing extra fees on NHIS cardholders erodes trust and equitable access to healthcare services. This directive aligns with NHIA’s mandate under the National Health Insurance Act, 2012 (Act 852), to regulate providers and protect subscribers.

Analysis

Unauthorized charges occur when NHIS-credentialed health facilities demand payments for services covered under the scheme, such as consultations, diagnostics, or treatments listed in the NHIS benefits package. These fees, often termed “under-the-table” or “protocol” charges, include extras for beds, drugs, or faster service—none of which are permitted without explicit NHIA approval.

Impact on Universal Health Coverage Goals

Ghana’s NHIS, established in 2003, covers over 50% of the population, targeting 100% coverage by expanding benefits like dialysis and cancer treatments. Unlawful charges disproportionately affect low-income subscribers in regions like Central Ghana, where poverty rates hover around 20-30%. Director Thompson noted that such practices contradict national efforts, as verified by NHIA annual reports showing thousands of complaints annually.

Monitoring and Enforcement Mechanisms

NHIA has deployed district-level monitoring teams equipped with claims validation software and subscriber feedback systems. In 2024 alone, over 500 facilities nationwide faced audits, leading to recoveries of millions of cedis in illicit fees. The Central Region’s intensified surveillance, as directed, uses real-time reporting apps to flag violations swiftly.

Summary

NHIA Central Regional Director Kojo Sekyere Koi Thompson urged NHIS providers in the Central Region to cease charging unlawful fees immediately. Speaking at a Dunkwa-on-Offin stakeholder forum, he outlined strict monitoring, potential sanctions, and calls for subscriber reporting. District NHIS manager Isaac Bofah highlighted connectivity issues hindering registrations, requesting offline solutions. This move reinforces NHIS compliance for universal health coverage in Ghana.

Key Points

Practical Advice

For NHIS subscribers and providers in Ghana’s Central Region, proactive steps ensure smooth operations and compliance.

For Subscribers: How to Verify and Report Unlawful Charges

Always present your valid NHIS card at credentialed facilities. Covered services include outpatient consultations (up to 10 visits/year), inpatient care, maternity, and select surgeries—check the official NHIS benefits list on nhia.gov.gh. If charged extra:

1. Ask for a breakdown in writing, citing NHIS guidelines.
2. Report immediately to your district NHIS office via phone, app, or in-person—provide facility name, date, amount, and receipt.
3. Use NHIS toll-free lines: 929 or regional hotlines for Central Region support.

Reporting strengthens transparency; NHIA resolved over 80% of 2024 complaints within 30 days, per official data.

For Health Facilities: Steps to Avoid Sanctions

Review your NHIA service agreement annually. Train staff on claims submission via the e-Claims system. Implement internal audits and display NHIS fee schedules visibly. Non-compliance risks contract termination, as seen in 2023 cases where 42 facilities lost accreditation.

Points of Caution

While NHIS covers core services, exclusions exist: non-essential cosmetics, experimental treatments, or private rooms unless approved. Subscribers must renew cards every two years and register promptly. Providers: Beware of “gatekeeper fees” or drug markups, which NHIA audits detect via subscriber volume discrepancies.

Subscriber Risks

Paying unlawful fees discourages reporting; cumulative extras can exceed GHS 500/year per family, per NHIA surveys.

Provider Risks

Sanctions escalate: warnings, fines (up to 10% of claims), suspensions (3-12 months), or blacklisting, impacting revenue from 40% NHIS-dependent facilities.

Comparison

Central Region’s challenges mirror national trends but are amplified by rural dynamics. In 2024, NHIA nationwide sanctioned 1,200 providers, recovering GHS 15 million—Central Region accounted for 15% of cases, versus 25% in Greater Accra due to higher volumes.

Vs. Other Regions

Ashanti Region leads in registrations (over 2 million active) but reports fewer connectivity issues thanks to urban broadband. Volta Region, like Central, struggles with offline access, prompting similar appeals. Nationally, urban facilities comply at 85%, rural at 70%, per NHIA’s 2024 compliance report.

Authorized vs. Unlawful Fees

Authorized: Co-payments for optometry (GHS 10) or non-NHIS drugs. Unlawful: Any extra for covered inpatient drugs or beds.

Legal Implications

Under National Health Insurance Act, 2012 (Act 852), Section 36 prohibits providers from charging NHIS subscribers for covered services—violations are misdemeanors punishable by fines up to 500 penalty units (GHS 6,000+) or imprisonment. NHIA’s Claims Processing and Payment Regulations, 2013 (LI 2201), mandate sanctions: temporary suspension or revocation of credentials. Courts have upheld cases, e.g., 2022 High Court ruling fining a facility GHS 50,000. Subscribers can seek refunds via district adjudication committees, with appeals to NHIA headquarters.

Conclusion

NHIA Central Regional Director Kojo Sekyere Koi Thompson’s warning underscores a collective duty to safeguard NHIS integrity. By halting unlawful charges, intensifying monitoring, and addressing connectivity gaps—like Upper Denkyira’s offline registration needs—Ghana advances toward universal health coverage. Subscribers, report boldly; providers, comply diligently. This ensures affordable, quality care for all, fostering a healthier Central Region and nation.

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