Shock as MPs clear 12 health facilities suspended over 'NHIF heist'

NHIF Building

The NHIF building in Nairobi. 

Photo credit: File I Nation Media Group

The National Assembly Departmental Committee on Health, led by Endebess MP Robert Pukose, wants the National Hospital Insurance Fund (NHIF) to immediately lift the licence suspensions of 12 out of 15 health facilities suspended over the 'NHIF heist'. It also wants NHIF to pay them "all outstanding verifiable claims".

This follows a year-long investigation into unscrupulous businessmen and medical facilities that defrauded the NHIF of over Sh7 billion by altering claims and falsifying information in collusion with NHIF officials.

The health facilities whose licence suspensions the Dr Pukose-led committee wants lifted include Afya Bora Hospital Annex, Afya Bora Hospital, Jekim Hospital Nkubu Ltd, Jekim Medical Centre, St Peters' Orthopaedic and Surgical Speciality Centre, Murang'a High School Dispensary, Chest and Skin Clinic, Garissa Nursing Home, Aljazeera Hospital, Medina Hospital and Charity Medical Centre.

This is despite an investigation by the Kenya Medical Practitioners and Dentists Council (KMPDC) which found these facilities guilty. In his submission, KMPDC chief executive David Kariuki told the committee that facilities such as Afya Bora Hospital and Afya Bora Hospital Annex were operating as level 4 hospitals, but did not meet the minimum standards to qualify as level 4 hospitals.

Presenting a report following joint investigations by KMPDC and NHIF, Dr Kariuki explained that the council conducts joint inspections with county governments to accredit facilities and that in some cases they rely on documentation from the counties rather than physically visiting the health facilities. This, he says, explains why facilities that do not meet the criteria to be classified as level 4 have "found a way" to operate as such.

"Joy Nursing and Maternity Eastleigh Limited was categorised as Level 2, not as Level 4," he said.

The committee also ordered Elburgon Nursing Home to move to new premises and apply for re-inspection after six months.

Beirut Pharmacy and Medical Centre, Amal Hospital Limited and Joy Nursing and Maternity Eastleigh Limited were referred to the Directorate of Criminal Investigations (DCI) for further investigation. The KMPDC also recommended the permanent closure of the facilities.  

This was after final audit reports revealed that irregular payments made by NHIF to Beirut Pharmacy and Medical Centre totalled Sh153,439,360. Joy Hospital Eastleigh was accused of defrauding the national insurer of Sh368,868,453, while Amal Hospital allegedly pocketed Sh33,473,542.

According to NHIF chief executive Elijah Wachira, Jekim Hospital Nkubu Limited, another health facility let off the hook by the parliamentary committee, breached clauses 16.6, 4.1 and 2.21 of the NHIF contract and was ordered to repay Sh1,004,220. Beirut Pharmacy was also ordered to repay some money.

"Beirut Pharmacy and Medical Centre should, therefore, payback Sh15,490,000 being payment of fraudulent claims and that 114 claims totalling Sh13,198,580 be rejected. Amal Hospital should pay back Sh7,653,000 and 237 claims totalling Sh32,248,500 be rejected," Wachira said in his submission to the committee.
The committee said 32 witnesses appeared before it from July 25 last year to February 15 this year.

"Wendy Marete, the administrator of Jekim Medical Centre, appeared before the committee on Monday, October 9, 2023, and responded to questions relating to allegations of organising medical camps (induced demand), identifying patients in need and referring them to Jekim Hospital Nkubu Limited for tests and X-rays and induced demand of Edu Afya by offering transport and snacks to students," the report says.

It further notes that Marete said NHIF had never complained to the facility and that the facility had a good working relationship with the health fund.

Dr Wachira Waigoko, the administrator of Afya Bora Hospital, told the committee that Dr Allen Sunny Deol had been accused of performing 76 major surgeries between January and March last year at a cost of Sh6,460,000.

The committee then wanted to know how Dr Deol could perform 21 major surgeries in one day (February 7, 2023). Dr Waigoko had no answer.

Dr Gerald Wasena, administrator at St Peters Orthopaedic and Surgical Specialty Centre, denied allegations that staff at his facility had been chasing old people for treatment in Meru County, Mt Kenya Region and Machakos County, among other places, for "specialised treatment".

"He said that the hospital held medical camps in various parts of the country as part of its corporate social responsibility," the committee said.

The parliamentary committee report highlights that between 2021 and 2023, NHIF's investment capital shrunk by Sh7 billion from Sh15 billion to Sh8 billion, which is why the health insurer has been liquidating short-term assets and "eating into reserves".

However, in an interview with the Nation on Wednesday, NHIF chief executive Elijah Wachira insisted that the national insurer would not pay the "outstanding verifiable claims" for the 12 health facilities cleared by MPs.

"The committee used instruments and powers that were at their disposal and may not have used the kind of audit mechanisms that we have because everybody has certain strengths and limitations," he told the Nation.

"We will, however, not lift the ban on the facilities. We looked at our contracts with each of these 15 health facilities and made a decision that was followed up by a report to investigative agencies," Wachira said.

He added that the government has a structure and that 'clearance' by parliament will not guide their decision.

"From a parliamentary perspective, they could be cleared, but because we have EACC, DCI and ODPP dealing with them, what EACC and DCI will tell us is what we shall do," the CEO said.

The Nation contacted Dr Pukose through phone calls and text messages but he did not respond.