undermines healthcare sustainability in Benue State’s public hospitals, draining a significant

percentage of NHIA funds annually and exacerbating inequities. This study aims to examine the

prevalence, patterns, and management strategies of NHIA fraud in selected public hospitals:

Benue State University Teaching Hospital, Federal Medical Centre, Makurdi, General Hospital,

Gboko, General Hospital, Otukpo, General Hospital, North Bank, and General Hospital,

Vandeikya, to inform policy reforms for Universal Health Coverage (UHC).

Grounded in Greed

and Grievance Theory, which attributes fraud to socioeconomic pressures, greed, and systemic

loopholes, the study adopted a qualitative case study and exploratory design. A purposive sample

of 31 participants, including hospital management (three Chief Medical Directors, three Financial

Managers, two administration officers), external stakeholders (3 HMO representatives, one EFCC,

one forensic investigator, 3 Health management organizations, four police investigation officers),

and eight NHIA subscribers, were selected.

Data were collected through semi-structured key

informant interviews (KIIs) Thematic analysis, using Braun and Clarke’s framework and NVivo

software, revealed five fraud types: falsification of receipts, patient fraud under false identity,

billing for unrendered services, ghost patient fraud, and overcharging. These fraudulent activities,

fueled by greed and inadequate oversight, elevate out-of-pocket expenses for healthcare services.

Management strategies include robust record-keeping, adequate staffing, and community

awareness, limited by digital and funding constraints. These fraudulent activities drain NHIA

resources, with annual losses estimated at 30% of funds, exacerbating healthcare inequities and

undermining trust in Benue’s public health system.

Recommendations include implementing

digital health record systems, strengthening staffing and training, and enhancing community

awareness campaigns to deter fraud and optimize resources. The study’s policy relevance lies in

guiding NHIA and BNSHIA to strengthen regulatory frameworks, integrate technology, and

promote stakeholder accountability, enhancing NHIA efficiency and advancing Nigeria’s UHC

goals by 2030.