KENYA— The National Health Insurance Fund (NHIF), has suspended the licenses of two hospitals for five years, Amal Hospital & Beirut Pharma, located in Nairobi County.

This was brought to light by acting NHIF CEO, Samson Kuhora, who revealed that the two hospitals have been suspended for five years for fraud.

The CEO was speaking to the Departmental Committee on Health at Parliament, led by Endebes MP Robert Pukose, who are probing the scandal-ridden NHIF’s latest mishap.

Moyale MP Jaldesa Guyo pressed Kuhora to shed light on how dubious claims were generated and paid without the NHIF doing due diligence.

Kuhora also revealed that the other mentioned hospitals in the recent Nation Media expose’, have had their licenses suspended and are under investigation, expected to be complete in 90 days.

The hospitals are Afya Bora Hospital, Afya Bora Hospital Annex, Jekim Hospital Nkubu Ltd, Jekim Medical Centre, Joy Nursing and Maternity Eastleigh, and St Peter’s Orthopaedics and Surgical Specialty.

The expose’ revealed how health facilities preyed on the elderly to mint millions and thus defraud the national health insurer.

Investigations into collusion between NHIF staff and the above-mentioned is underway with the suspected staffer on suspension.

The NHIF officials are accused of using the tactic to fleece Kenyans and the government of an estimated US$11.4 Million.

“Investigations have found that there was fraud in terms of the members who accessed the service as media reported, Amal Hospital and Beirut Hospital which are based in Eastleigh have been found guilty, the reports completed and submitted to the board,” Dr. Kuhora told the committee.

Although, the CEO noted the suspended hospital can seek redress in two years.

Uncovering the mire at the National Health Insurer

MPs further disclosed that they have official reports on how some NHIF staff were colluding with India-based healthcare providers to siphon millions through dubious medical claims and payments.

“We acknowledge that fraud and corruption have regrettably infiltrated the health sector, posing significant challenges to the achievement of our mission in providing equitable healthcare access,” the CEO noted.

Dr. Kuhora added that an impact assessment study presented to the board in 2020 estimated the medical fraud risk to be 29.3 percent.

On what NHIF is doing to curb fraud and corruption, the MPs were told the insurer had introduced biometrics.

“The incorporation of biometric verification has bolstered our authentication processes, ensured the accurate identification of beneficiaries, and minimized identity related fraud,” the acting CEO assured.

Dr. Pukose, the committee chairman, however, pressed the NHIF to detail how it was safeguarding itself from fraud linked to healthcare providers.

Additionally, the Kenya Pharmaceutical Distributors Association Chairperson Dr. Kamamia wa Murichu told the MPs that hospitals grossly abuse the process.

Dr. Murichu added that hospitals were charging exorbitant amounts, two to five times more for the generic version of medicine but indicate the price as it would cost for the original version of the drug when they are claiming money from NHIF.

According to Dr. Murichu, a drug that costs less than US$5.5 at the chemist’s would cost four or five times higher when a hospital makes the claim to NHIF.

“When the claim is being sent to NHIF, it will be indicated as the original version of the drug,” he said.

NHIF’s in a loss-loss battle with the Kenyan government

At the same time, it has emerged that NHIF made losses amounting to approximately  US$42 million due to the non-remittance of premiums by the government.

Dr. Kuhora, however, pointed out that in the last financial year, the NHIF has had challenges with getting premiums from the government.

“We usually have the premiums paid within the first 90 days of the financial year, so within quarter one we usually anticipate that the payments have been made,” he said.

Unfortunately, Kuhora noted that in the last financial year, NHIF has had challenges with remittances from government entities and that is what has led to the accumulation of funds.

Finance officer at NHIF Francisca Mwanza highlighted that the NHIF’s investment capital was reduced by US$50 M between 2021 and 2023 from US$105 million to US$55 million.

“This is why the health insurer had been liquidating short-term assets and eating into reserves,” Mwanza explained.

Seme MP James Nyikal faulted NHIF for giving government institutions services on credit which he said was sinking the fund.

“Isn’t it discriminatory and against the law that when voluntary NHIF contributors’ default on payment you not only deny them services but also penalize them yet for government schemes you allow them to operate on credit?” Dr. Nyikal posed.

The committee is expected to continue with the probe with the Health Cabinet Secretary scheduled to appear before it.

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