Perception of Enrollee Health Insurance Fraud among Healthcare Workers at a Tertiary Hospital in Kaduna State, North-western Nigeria.

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 longterm strategic measures and technology-based solutions.