NHIA suspends 3 pharmacies over suspected fraudulent NHIS claims

The National Health Insurance Authority (NHIA) has announced the immediate suspension of three pharmacies from participating in the National Health Insurance Scheme (NHIS) over allegations of suspected fraudulent claims and irregular service transactions.

The suspension, which took effect on Thursday, May 14, 2026, follows a routine claims verification exercise conducted by the Authority as part of efforts to protect the integrity and sustainability of Ghana’s national healthcare insurance system.

In an official public notice issued by the NHIA, the affected pharmacies were identified as DELDEM PHARMA LIMITED, PARAMEDICA PHARMACY and DESH CHEMIST.

According to the Authority, preliminary investigations uncovered significant irregularities linked to claims submissions and service transactions involving the facilities.

The NHIA stated that the findings raised “reasonable suspicion of fraud and abuse” under the terms of the NHIS Provider Service Agreement, prompting the decision to impose an immediate temporary suspension pending further investigations.

As part of the sanctions, the affected pharmacies are prohibited from providing pharmaceutical services or dispensing medications under the NHIS until further notice from the Authority.

“The pharmacies are not permitted to provide services or dispense medicines under the NHIS during the suspension,” the NHIA stated in the notice.

The Authority has therefore advised NHIS subscribers and members of the public who require pharmaceutical services to seek care from other accredited healthcare providers and pharmacies nationwide to avoid disruptions in accessing medications.

“NHIS members who require pharmaceutical services are encouraged to seek care from other credentialed NHIS providers nationwide,” the statement added.

The NHIA emphasized that the move forms part of broader measures aimed at strengthening transparency, accountability and efficiency within Ghana’s health insurance system.

Healthcare fraud and false claims have long been identified as major threats to the sustainability of public health insurance schemes globally, often resulting in financial losses that affect service delivery and access to quality healthcare.

The Authority issued a stern warning to all accredited healthcare providers, stressing that any form of fraud, abuse or manipulation of claims processes will not be tolerated.

“The Authority will not tolerate fraudulent or abusive practices that undermine the sustainability of the NHIS, which may deprive members of quality healthcare services,” the statement warned.

The NHIA further reminded service providers of the legal implications of engaging in fraudulent activities under the Scheme.

According to the statement, any healthcare provider found guilty of defrauding or attempting to defraud the NHIS commits a criminal offence and may face severe penalties under Ghanaian law.

“A healthcare provider providing services under the National Health Insurance Scheme who defrauds or attempts to defraud the Scheme commits an offence and is liable on summary conviction to a fine or a term of imprisonment of not more than ten years or both,” the Authority cautioned.

The statement, signed by the Chief Executive Officer of the NHIA, Dr. Victor Asare Bampoe, reaffirmed the Authority’s commitment to safeguarding public funds and ensuring that healthcare resources are used responsibly for the benefit of all Ghanaians.

“The NHIA remains committed to ensuring transparency, accountability, and the prudent use of public funds in delivering accessible and quality healthcare to all residents of Ghana,” the statement concluded.

The development comes at a time when the NHIA continues to intensify monitoring and auditing mechanisms aimed at detecting irregularities, improving service delivery and preserving public confidence in the National Health Insurance Scheme.