Revealed: NHIF Loses Ksh.20B Through Fake Claims, 27 Hospitals Suspended
The Ministry of Health disclosed that approximately Ksh.20 billion has been squandered via the National Health Insurance Fund (NHIF) program due to fabricated claims and deceptive medical procedures, among other fraudulent activities carried out by healthcare facilities.
Health Cabinet Secretary Wafula Nakhumicha disclosed on Friday that a scandal impacting health facilities was unveiled. He revealed that among 67 hospitals audited in the nation, 27 had been suspended due to the mismanagement of Ksh.171 million within the NHIF program.
CS Nakhumicha reported that approximately 40 percent of all the country’s hospitals (3,440 in total) engaged in irregular procedures, leading to a loss of Ksh.20 billion.
“Between January and December 2023, out of 67 audited hospitals, 27 were found to be involved in fraudulent activities, resulting in a loss of Ksh.171 million,” she stated.
“Extrapolating this to the total population of 8,886 hospitals, it is estimated that approximately 3,440 might have been engaged in fraudulent activities, potentially exceeding Ksh.20 billion in losses from about 40% fraudulent hospitals. Luckily 60% carry out clean business.”
During the recent action conducted by the newly introduced Social Health Authority (SHA), the Chief Executive Officer mentioned deceitful actions like creating false demand to exploit vulnerable individuals like the elderly, activating inactive member accounts through misleading methods, and funding unnecessary medical treatments as part of fraudulent activities.
She mentioned that the older population was primarily focused on in regions such as Nairobi, Meru, Nyahururu, Muranga, Kerugoya, Makueni, TharakaNithi, Subukia, Nanyuki, Bungoma, Chuka, and Machakos.
The computer scientist further mentioned that certain establishments might possess fabricated records suggesting that employees had undergone significant surgeries while still on duty. Additionally, some places might employ security guards from authorized security companies and incentivize them financially to supply biometric data for deceptive intentions.
As per Nakhumicha, the ministry found irregularities where medical centers, originally capable of performing just two eye surgeries daily, were carrying out between 10 to 22 surgeries. This raises doubts about the credibility of their reports and the resources they have at their disposal.
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In the same vein, the ministry discovered another instance of fraud related to the EduAfya program. This involved healthcare facilities luring healthy students by offering them food incentives in exchange for their biometric data, leading to significant financial losses.
“Additionally, cases involving nurses stationed in schools collecting biometrics of non-ill students to lodge fictitious claims have been unearthed, significantly exploiting the scheme,” she revealed.
The government department has assured the public that they are working on restoring trust in healthcare services, mentioning that they have already recovered Ksh.17.7 million out of the Ksh.171 million lost, as part of their efforts to recover the claims.
Several hospitals have been implicated in fraudulent activities related to the NHIF scheme, and efforts to reclaim funds have been initiated in these cases.
Jekim Hospital Meru, Jekim Medical Centre, Joy Nursing & Maternity, Amal Hospital Ltd, Beirut Pharmacy and Medical Centre, St. Peter’s Orthopedic and Surgical Specialty, Afya Bora Hospital Annex Ltd in Mwea, Charity Medical Centre, Queens and Kings Hospital, Chest & Skin Clinic, and Kiritiri Medical Healthcare are among the healthcare facilities included.
Others are Meswo (Tunza) Medical Services, Familia Bora Medical, Naivasha Quality Healthcare, Bingwa Family Clinic, Elburgon Nursing Home, Nyamira Jamii Medical, St. Joseph Shelter of Hope, Lenmek Hospital, Equity Afia Buruburu, Muranga High School Dispensary, Mathingira Medical Centre, Ruai Medical Centre and Thuti Medical Clinic.
Revealed: NHIF Loses Ksh.20B Through Fake Claims, 27 Hospitals Suspended