Unmasking the NHIF Scandal: Elderly Exploited, Millions Made by Rogue Health Facilities
Eight months ago, wolves in sheep’s clothing appeared in the sleepy villages of Meru County.
Men and women posing as healthcare professionals misrepresented the National Health Insurance Fund (NHIF) to the villagers. Promising to rescue them from the depths of arthritis complications.
They only needed to dress appropriately, carry their NHIF cards. And travel for free to certain health facilities in Nairobi County to receive free medical care.
Since then, months have passed, leaving residents of the rural county in agony and tears. As they recount the resulting disabilities and deaths.
Mr. Mwebia M’miriti, who is now a widower. Recalls how his community was mobilized in October 2022 to attend a free arthritis medical camp at Nkubu Stadium.
Produce cards
Guests were required to present their NHIF cards, and those with alternative medical cards were denied entry.
The patients were then asked to describe their symptoms before being instructed to undergo X-rays. Mr. Mwebia was instructed to locate a medical facility for a back x-ray and then to report the results.
He disregarded the call. However, his wife was advised to visit a private medical facility in Chuka for the same reason. And a vehicle was provided at no cost to transport her and others.
Back at the camp, they informed her that she required surgery. Later that evening, camp officials would provide her with a free ride to Nairobi in a vehicle.
The following day, following the surgery, Mr. Mwebia spoke with his wife on the phone. Who informed him that she was at St. Peter’s Orthopaedic Hospital in Kiambu County.
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Mr. Mwebia reports that his wife was in good health, although she occasionally complained of pain in her lower limbs. However, she never felt the need to see a doctor and instead relied on a pain balm. “She only came to the camp because it was close to her home and free,” he explains.
She stated that she was exhausted, so he left her to rest.
It was their last conversation. Mr. Mwebia received a text message informing him that Sh300,000 had been paid using his card while she was still in the hospital.
However, he is uncertain as to whether the full amount was deducted for his wife’s treatment, as she passed away soon after, alone and far away.
The hospital in Kinoo, Kiambu County, offered to transport the body to the Nkubu mortuary and pay for all funeral services there. She was buried without a postmortem examination being conducted days later.
Orthopedic surgeon and owner of St. Peter’s Hospital, Dr. Jerry Wasena. Told GossipA2Z that the patient required surgical intervention because they believed she had grade three osteoarthritis.
We have a program in which we receive patients from Chuka because there is no surgical facility in Meru. Here we did everything to ensure the surgery was necessary. A blood test, checked kidney function, and we felt the patient would benefit from surgery. Unfortunately, on day two when the patient started to walk. She experienced difficulty breathing and died within a very short time.
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Dr. Wasena claims that the patient was brought to their facility, but Mr. Mwebia claims that his deceased wife was picked up at a medical camp.
“We have our van that transports patients from Chuka to here regularly. We have a program where we go do outreach and bring patients from wherever to here,” he says, admitting, “I didn’t know that you needed permission from the medical council to conduct a medical camp.”
Mr. Douglas Kiraithe, a fellow villager of Mr. Mwebia. Recalls being summoned to Ntharane market by a man named Winfred Kathure. Who claimed to be an expert in treating arthritis, a condition characterized by joint inflammation and stiffness.
She (Winfred) persuaded them that President William Ruto had inaugurated the hospital and that, once treated, the condition would not return.
Mr. Kiraithe explains, “There were over a hundred of us, and we were thrilled to hear that NHIF would cover the costs and that those without the cards would not be able to receive treatment.” “On the same day, seven of us went to Jekim Hospital for X-rays. On the way back in their car, one of the officials examining the x-rays said I would have an operation, while others would be given medication. Two days later, sixteen of us were picked up in the evening in a Nissan matatu. We arrived in Nairobi at 11 pm, with a driver who did not know where he was going,” he adds.
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Six individuals were eventually dropped off at various facilities. And the remaining ten, including Mr. Kiraithe, were driven to Joy Nursing and Maternity Hospital. Where they were registered and instructed to wait.
Presented an injection
We did not know where the women were being taken. Eventually, I was given an injection in my right thigh and 30 tablets to take once a day for 30 days. That evening, I received a text message informing me that I had been discharged and that NHIF had paid Sh130,000,” he says.
In a claim, the hospital stated that it had performed an open reduction and internal fixation procedure on Mr. Kiraithe and several other patients at the same cost.
According to Hopkins Medicine, the surgery is performed to stabilize and heal a fractured bone, and a patient may require it to treat a fractured femur.
“I heard I had an operation. Can these people show me where they operated?” “This woman (Winfred) showed up when I began speaking with journalists and told me, ‘Stop defaming the hospital’s name. I will have you treated without a fuss.'”
Ms. Grace Karuma of Kithare village is more distressed. Mrs. Kainda M’Arithi, her mother, had an amputated leg.
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According to Karuma, her district assemblyman informed her of the camp and urged her to visit Gatune Primary School.
Her 80-year-old mother climbed a steep hill to reach the school, hoping to experience pain-free movement for the remainder of her life. The following day after the camp, she and others were taken to Jekim Hospital for x-rays.
Mrs. Kainda was informed that her leg was infected, full of pus and that she must travel to Nairobi for treatment. Three days later, she and other villagers were transported to the capital.
Ms. Karma explains, “I called my niece in Nairobi and informed her that her grandmother was coming for treatment. After three days of no progress, I called my cousins in Nairobi and asked them to find her and cancel the operation, but they were told they would be required to pay a fee.”
“The day after the surgery, my mother and others were dropped off at Nkubu at 2 am, unable to walk. I hired a taxi to take my mother home and then took the others to their families. At home, we carried my mother around and took care of her, almost putting her in diapers,” she explains.
Mrs. Kainda’s fellow villagers, Ms. Harriet Miraitho and Ms. Agusta Gatwiri share the same story and anger at Joy Nursing Hospital for robbing them of their God-given ability to walk.
Ms. Miraitho’s situation is exacerbated by the fact that Mr. Kiraithe’s warning and the concerns of various villagers have gone unheeded.
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Two women, along with twelve others, were given the same injection and similar tablets (Diclofenac and Osteocare) and told to wait six months between October 26 and October 27.
“I was told I had a small bone fracture and given two injections, one in each thigh. The next morning I woke up fine, but on the way home my legs started to hurt. I had a shower on arrival and the pain moved down my hip. I was taken to the hospital and stayed there for two weeks, unable to walk. When I was finally discharged, I could not lift myself,” says Ms. Gatwiri, adding that NHIF sent her a letter saying it had paid Sh130,000 for her medical care.
Since receiving two injections, Ms. Miraitho has become bedridden and disabled. At the time of the interview, her family was organizing a fundraiser to assist her in obtaining better medical care.
Joy Nursing Home on Juja Road in Eastleigh, Nairobi, would be where Ms. Gatwiri and Ms.
The NHIF paid Sh130,000 for Ms. Gatwiri’s treatment, which consisted solely of injections, less than 24 hours after she arrived at the hospital.
Impotent to walk
Ms. Miraitho claims that she was treated without an NHIF card, which raises the possibility that her bills were charged to someone else’s card. Now unable to walk, she reminisces over her old photographs.
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“I didn’t pay a dime. They told me the NHIF card didn’t work, and when I asked them when NHIF would settle the bill, they remained silent. To this day, I have never received a message telling me to pay. If we had known that was going to happen, we wouldn’t have gone. I thought people were just politicizing the initiative. We were told that President Ruto had donated money to treat people and was encouraged to share with friends so that we could all benefit.”
Dr. Samson Kuhora, the interim chief executive officer of the NHIF, cites impersonation as one of their greatest obstacles. “It is possible that someone else’s card was used in this instance,” he said.
According to Mr. Salesio Mutuma, the whistleblower, his petition to the Meru County Assembly and email to NHIF requesting an investigation were neither acknowledged nor responded to.
The rogue medics target elderly women and men with leg or knee problems.
Meru County’s Chief Officer of Health Services, Dr. Joseph Wahome, states that he has received complaints from individuals conducting medical camps in the county and that they are investigating the complications involved.
No one had requested permission from the county government to operate the camps, he added.
At one of the medical camps attended by the Nation in Subuiga, the camp staff claimed to represent Afya Bora Hospital.
However, the hospital denied organizing any medical camps or recruitment campaigns in the district. In addition, they denied defrauding NHIF.
According to St. Peter’s Orthopaedic Hospital, Mrs. Mwebia had stage three osteoarthritis (knee arthritis), had successful surgery and recovery, but died of a blood clot.
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This stage of arthritis, according to the Illinois Bone and Joint Institute, should be treated with injections into the knee joint over three to five weeks. Surgery is only required during the fourth and most severe stage.
Dr. Kuhora told Nation that there are several instances in which the date of birth recorded in the system differs from the claim.
“This then indicates that there is a particular pattern in that direction; this person likely has inside knowledge that one of the monitoring indicators is the age group of the patient, so there is a possibility that it is a pattern,” he said.
At the medical camp in Subuiga, GossipA2Z met patients whose expired NHIF cards prevented them from receiving treatment.
NHIF subscription
Six individuals claiming affiliation with the Afya Bora Hospital in Nairobi organized this camp.
At the camp, the hospital’s name is displayed on posters and in the documentation provided to patients. Including a reporter from The Nation who was treated there.
Mr. Francis Muthomi stated that his NHIF subscription was not current. And he was asked to remind his son to update it before he is transported to the hospital for further examinations.
In response to queries from the GossipA2Z. Dr. Wachira Waigoko of Afya Bora stated that his facility has never conducted medical camps in Meru. And has never participated in a patient recruitment drive.
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Afya Bora Hospital has never conducted a medical camp or patient recruitment drive in Meru County. Afya Bora Hospital has also never participated in defrauding NHIF. We have a legal contract that stipulates the obligations and responsibilities we have to our patients and the insurer as a financier of healthcare. We have always complied with these, and it is a continuously monitored and audited process.
And at Dr. Waigoko’s request, the acting head of the NHIF confirmed that two facilities have been investigated and found to be at fault, including one of Dr. Waigoko’s hospitals, Afya Bora Hospitals.
Poor patients
Eight hospitals were paid Sh1.54 billion for a total of 30,111 claims made between July 1, 2022, and June 9, 2023, despite concerns that private hospitals are excluding low-income patients because of unpaid NHIF fees.
Afya Bora Hospital (Sh7.4 million), Afya Bora Hospital Annex (Sh239.8 million), Amal Hospital Limited (Sh37.8 million), Beirut Pharmacy and Medical Centre (Sh72 million), Jekim Hospital Nkubu Ltd (Sh84.2 million), Jekim Medical Centre (Sh2.9 million), Joy Nursing and Maternity Eastleigh (Sh222.6 million), and St Peter’s Orthopaedics and Surgical Specialty (Sh681.6 million).
Dr. Kuhora acknowledges that they face a problem with medical fraud, primarily through impersonation.
Two hospitals in this special report have already been investigated and found to be at fault, he adds. “It will only be a matter of days before action is taken, which may include terminating their contract with the NHIF.”
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Mr. Mutuma, who has since petitioned the Meru County Assembly to investigate the matter. Claims he reported it to the appropriate authorities, including NHIF. And that his November 2022 email was neither acknowledged nor responded to.
In actuality, the NHIF did not respond to Mr. Mutuma’s concern until almost eight months later, on June 2, 2023. Possibly demonstrating a disregard for public concerns regarding the potential loss of public funds through a much-hyped anti-fraud feedback system.
Three days earlier, GossipA2Z had conducted an official interview with Dr. Kuhora. And mentioned their lack of seriousness in addressing public concerns.
Unmasking the NHIF Scandal: Elderly Exploited, Millions Made by Rogue Health Facilities
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