Perception of enrollee health insurance fraud among healthcare workers at a tertiary hospital in Kaduna State, north-western Nigeria

Abstract

Background: Fraud in healthcare is an immense challenge that poses a direct threat to sustainable healthcare
financing across low and high-income countries. Enrollee health insurance fraud is a relatively understudied form
of fraud that thrives in settings characterized by weak and fragmented healthcare systems. This study examined the
knowledge and perception of enrollee health insurance fraud among healthcare workers at a tertiary hospital in
Kaduna State, North-western Nigeria.
Methodology: Using a stratified sampling technique, 232 healthcare workers were interviewed using a structured,
self-administered questionnaire that was developed for the study. Data on knowledge and perception of enrollee
fraud was obtained and analysed using IBM SPSS Statistics. The data was presented using frequency distribution
tables, while figures were drawn using Microsoft Excel.
Results: The majority of the respondents were clinical staff, including medical doctors (29.7%), nurses (31.5%)
and health assistants (14.2%). A total of170 (73.3%) respondents were aware of enrollee fraud and up to 113
(66.5%) encountered at least one case of enrollee fraud. The most common types of enrollee fraud identified by the
respondents were impersonation (67.7%) and faking symptoms (57.1%). Respondents recognised adverse
consequences of enrollee fraud, including depletion of resources (74.1%), blocking eligible patients from accessing
care (73.6%), and exhaustion of healthcare workers (61.8%). A total of 111 (65.3%) agreed that enrollee fraud is
common in the hospital and despite a high level of awareness, only 72 (42.3%) agreed that they are adequately
informed about enrollee fraud.
Conclusion: There was a high level of awareness of enrollee fraud among the respondents with a good perception
of its manifestations and implications on healthcare delivery. It is recommended that immediate steps be taken to
educate healthcare workers and enhance their capacity to detect and deter enrollee fraud while investing in long
term strategic measures and technology-based solutions.