The hospitals accused of using forged documents to file fraudulent claims and loot the National Health Insurance Fund (NHIF) could not have done it on their own. This has always been an elaborate scheme in which insiders have played a pivotal role.
Some of the thefts were unbelievably blatant and it is good that they have now been unmasked.
It is precisely why the planned reforms in the health insurance sector cannot wait any longer. Indeed, the scrutiny of the new Social Health Insurance Fund (Shif) should be enhanced to prevent such shenanigans once it is given the green light.
The NHIF will cease to exist from the end of the year and these revelations are just what the doctor ordered to streamline public health insurance. NHIF Chief Executive Officer Elijah Wachira has been spilling the beans before the Senate Health Committee, adding that staff have been colluding with private hospitals to defraud the fund of billions of shillings.
The national health insurer is now seeking reimbursement of more than Sh49 million from eight hospitals embroiled in the malpractices. Two of the culprits have been sacked while 12 underwent disciplinary action. The fate of the other nine has to be determined by the board of directors.
This is too lenient, however. Their partners in crime and the hospitals they own or run should also face criminal proceedings and be forced to refund what they stole from the taxpayers and NHIF members.
This rare admission by the fund’s boss on how it has been so easy for the crooked insiders to help wayward health service providers to siphon out public funds is an important lesson on what needs to be done to review the rules and regulations and tighten controls to enhance access to affordable quality medical care by Kenyans throughout the country.
All the suspects should be rounded up and arraigned and, if found guilty, appropriately punished to act as a deterrent for would-be offenders. And all the looted funds recovered.