MPs want health facilities probed over NHIF claims

Friday, November 25th, 2022 04:00 | By
Chief Executive Officer at National Hospital Insurance Fund(NHIF) Peter Kamunyo (right) and his chair Lewis Nguyai when they met members of the National Assembly’s Health Committee yesterday. PD/Kenna CLAUDE
Chief Executive Officer at National Hospital Insurance Fund(NHIF) Peter Kamunyo (right) and his chair Lewis Nguyai when they met members of the National Assembly’s Health Committee yesterday. PD/Kenna CLAUDE

The National Assembly Committee on Health will train the spotlight on health facilities involved in fraud which has seen the National Hospital Insurance Fund (NHIF) lose billions of shillings through fictitious claims.

While on a familiarisation tour at the NHIF head office in Nairobi yesterday, the Committee heard that unscrupulous staff members in some health facilities were helping patients to make false claims using their biometric signatures.

The committee recommended that such facilities be exposed and punished.

As a result, a number of health facilities may lose their operating licenses and be forced to refund the NHIF billions allegedly defrauded by their own staff through fictitious claims.

“We have learnt that in some facilities, patients were using staff to key in biometric for false claims. That’s serious fraud,” said the committee’s chairman Robert Pukose.

He said any facility caught doing that should be deregistered and be forced to return the amount of money defrauded.

Fully digitised

Fraud was identified as one of the avenues through which the insurer was experiencing leakages amounting to billions of shillings, partly due to a weak foolproof digital system.

The members of the committee recommended that the board, together with the management, find ways of sealing the loopholes.

Board chairman Lewis Nguyai revealed that the leakages could be somewhere in the range of 10 to 20 per cent. He said that until the fund is fully digitised, it will continue to lose money.

“The question of leakages is one that’s difficult to quantify, and if they are there, it means that they are not in our purview. However, we can only do an estimate, and could be somewhere around 10-20 per cent,” he said while responding to questions raised by the Members of Parliament and journalists.

He exuded confidence, though, that the Board and the management were in the process of finding out the full amount of leakages “once we have fully computerised.”

However, he said, there has been a tremendous improvement, with a 100 per cent e-claim process.

“This means that 100 per cent of our claims are digital,” he said.

Last year, NHIF Chief Executive Officer Peter Kamunyo revealed that the Fund was losing an estimated Sh10 billion annually through fraudulent claims.

He said the money was lost through impersonation and fictitious claims by public and private hospitals in the process denying millions of deserving Kenyans quality health care.

Further, Kamunyo revealed that they had discovered the fake claims by looking at some trends.

He cited the case of a woman who used her NHIF card in Eldoret, gave it to her mother to seek treatment at a health facility in Kitengela and Nairobi Hospital, and later the cardholder used it at Coptic hospital, all within a month.

“We realised it when we were told the patient’s mother died, and then as we were processing the payments, the same card was used by the owner who had delivered at Coptic Hospital, so through the different activities we got to know that different people had used it,” he said.

The MPs were concerned that the fraud involved staff at health facilities, and recommended that stiff penalties should be handed down to offenders.

Staff shortages

Responding to a presentation by Kamunyo on the Fund’s recent performance, Pukose called on the Board to urgently address the leakages.

“For the last two years, they made Sh3.2 billion. Last Financial Year they made Sh2.7 billion. So this helps us to establish that in the past there were serious leakages. However, the Fund needs to put in a foolproof system to curb these leakages,” he said.

The MPs said for the Universal Health Coverage (UHC) to be achieved, the Fund should operate at an optimum by addressing staff shortages.

“We had an opportunity to visit the call centre and we found out that they receive 13,000 calls a day but they are only able to do 3,000 calls. This means that the rest of the population may feel dissatisfied, or their needs have not been addressed,” Pukose said.

Nguyai revealed that the Board and management were in the process of identifying staff members who were brought in through political connections, with the aim of offloading them.

The Committee is today expected to visit the Kenya Medical Supplies Authority (Kemsa) in their fact finding mission.

More on News



Notice: Undefined offset: 0 in /home/mediamax/httpdocs/ on line 690

Notice: Trying to get property 'name' of non-object in /home/mediamax/httpdocs/ on line 690