MPs Grill NHIF Boss Over Fake Claims Payouts
On Tuesday, lawmakers intensified their scrutiny of NHIF CEO Samson Kuhora regarding fraudulent claims and payments to healthcare facilities.
MPs are investigating the unlawful payment that connects him to the suspicious payments.
The legislators have initiated a 90-day investigation into the circumstances surrounding the payment of fraudulent claims. They questioned how Kuhora was promoted to the top position despite having worked in the department that authorized payments, claims.
Jaldesa Guyo, a member of parliament for Moyale, alleged that the agency’s interim chief executive officer had worked in the claims department before his promotion to the position of agency head.
“I suspect that you were promoted to interim CEO to conceal what you have been doing. “We are investigating what you were doing in your position three months ago unless you can demonstrate otherwise,” Guyo said.
The lawmaker demanded that Kuhora explain how the anomaly that siphoned off millions from taxpayers was handled by the national health insurer.
“Everything we’re investigating is the CEO’s responsibility, and he needs to come clean about the facilities that charged 20 times or more the approved rate,” he said.
Dancun Maina, a member of parliament for Nyeri Town, inquired as to why the state agency conducted market research on the prices of medicines to guide payouts after it was revealed that NHIF relied on the Essential Medicine List (EML).
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Kuhora told the committee, “We have not conducted market research because we rely on the EML system to guide us.”
Kuhoraa denied allegations of extending the payments for claims.
Before my promotion, I worked in the data analytics department and was not responsible for case management, which is the responsibility for claims payment approvals, he told the committee convened by Robert Pukose, an Endebes MP.
The CEO was also urged to explain how one officer from the case management department approved sixty percent of the fraudulent payments to hospitals.
In addition, he was criticized for the existence of a cartel at the health insurer that collaborated with cartels from outside the country to defraud the agency.
Health Cabinet Secretary Susan Nakhumicha suspended eight fraudulent health facilities, including Amal Hospital Limited and Berut Pharmacy and Medical Centre, and ordered a comprehensive investigation into the payment of these fraudulent claims.
Jekim Medical Centre in Meru, St. Peter’s Orthopaedic and Surgical Hospital in Kiambu, Afya Bora Hospital in Kirinyaga, Joy Nursing and Maternity Hospital in Nairobi, and Afya Bora Hospital Annex in Kirinyaga are among the other suspended facilities.
Kuhora clarified that the suspended facilities will remain suspended per the terms of the contract, which stipulate a 90-day suspension to allow for a comprehensive investigation.
“If fraud is confirmed, the board may approve a five-year suspension by the terms of engagement, and the facility may file an appeal after two years,” he explained.
MPs Grill NHIF Boss Over Fake Claims Payouts
