MPS LAUNCH AN INVESTIGATION INTO HOSPITALS' FALSE NHIF CLAIMS.
"It is alarming to learn that certain hospitals have singled out security guard groups from authorized security companies and paid them to provide their biometrics for purportedly fraudulent reasons," the spokesperson said.
The investigation into possible financial malfeasance in certain health facilities nationwide is still ongoing in the counties of Embu and Meru.
The Committee on Health of the National Assembly is gathering information and looking into numerous hospitals that may have conspired with dishonest officials to steal money from the National Health Insurance Fund (NHIF).
The MPs toured many locations in Murang'a and Kirinyaga on Wednesday, escorted by Vice Chairperson Patrick Munene of the committee.
Pauline Lenguris (Samburu), Cynthia Muge (Nandi), and Mary Maingi (Mwea) were among the other members in attendance.
The committee was informed that a school dispensary in Murang'a, which is properly registered with the Medical Practitioners and Dentists Board employs over 150 staff members in addition to 2,400 students.
Even though the institution denied any involvement in fraudulent claims, MPs heard that the huge spike in claims was linked to a fee hike from Sh500 to Sh1,000.
During their visit to two hospitals in Mwea, Kirinyaga, the MPs also asked the owners of the facilities if it would be possible to perform 22 procedures in one day.
Munene also expressed worry about the quick acquisition of pre-approvals.
The Medical Practitioners and Dentists Board's licensing procedure was questioned when it was discovered that the facilities did not fully satisfy the standards for a level four hospital.
Despite denying any collaboration or false claims, the owner did state that he had to fire 98 workers since the NHIF had not yet paid the outstanding balance.
To demonstrate its dedication to serving the interests of the people, the committee promised justice and fairness.
On January 5, the Ministry of Health announced that an audit carried out in 27 healthcare facilities from January to December 2023 revealed that the national insurer had lost Sh171 million as a result of fraudulent actions.
Between January and December 2023, 67 institutions underwent audits, according to Susan Nakhumicha, the secretary of the health cabinet.
"Applying this to all 8,886 hospitals, it is calculated that roughly 3,440 may have been involved in fraudulent activities, with losses from roughly 40% of fraudulent hospitals potentially surpassing Sh20 billion." Fortunately, 60% conduct business in a clean manner," she said.
The Social Health Authority recently took over the National Health Insurance Fund (NHIF), from which the 27 facilities had been filing false claims, according to a statement sent by the CS to media outlets.
"It is somewhat alarming how common these claimed fraudulent situations are. Induced demand has been documented in the list of facilities involved, with a focus on older and more vulnerable persons in particular, the speaker said.
According to her, there were facilities in Nairobi, Meru, Nyahururu, Muranga, Kerugoya, Makueni, Tharaka Nithi, Subukia, Nanyuki, Bungoma, Chuka, and Machakos where the purported scam took place.
The CS said, "Patients have been tricked into needless medical procedures, taking advantage of their vulnerabilities."
She claimed to have discovered cases of "induced sickness," in which establishments fraudulently reactivate members' inactive accounts to pay for unnecessary medical procedures.
She continued by saying that the Fund has reportedly been defrauded through the use of fabricated data, fake claims, and misleading tactics such as falsely claiming that members are having significant procedures while they are employed.
"It is alarming to learn that certain hospitals have singled out security guard groups from authorized security companies and paid them to provide their biometrics for purportedly fraudulent reasons," the spokesperson said.
The CS went on to say that abnormalities had also been found, such as establishments performing an abnormally high number of eye surgeries in a single day—between 10 and 22—in facilities that could only handle two surgeries per day and lacked sufficient theater space.
"These disparities cast serious doubt on the veracity of the claims made and the resources offered by these facilities," Nakhumicha said.
According to the CS, healthcare facilities have been luring healthy students with food incentives under the EduAfya cover, resulting in significant financial losses from their biometrics.
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