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NHIF fraud: Amal and Beirut hospitals suspended for five years
National Health Insurance Fund board chairman Michael Kamau (left) and acting CEO Samson Kuhora before the National Assembly’s Health committee at Parliament buildings on July 25, 2023..
Internal investigations by the national health insurer into how rogue facilities preyed on unsuspecting elderly people in Meru County have found Amal and Beirut hospitals, both based in Eastleigh, guilty of fraud.
While appearing before the National Assembly’s Health committee chaired by Dr Robert Pukose (Endebess), National Hospital Insurance Fund (NHIF) acting CEO Samson Kuhora disclosed that other hospitals are under investigation. These include 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 Center.
“Investigations have found that there was fraud in relation to members who used the service as reported in the media. Amal Hospital and Beirut Hospital, which are based in Eastleigh, have been found guilty and reports have been completed and submitted to the board.
“For the others, the investigations, which started on June 16, are still ongoing and are expected to be completed in 90 days,” Dr Kuhora told MPs.
He further explained that health facilities found to have been involved in fraud are suspended for five years and can appeal the decision after two years.
“What we usually recover is the amount lost by NHIF, we then file reports with other investigating agencies to take other legal action, but what we are currently recovering is the amount listed as lost by the fund,” Dr Kuhora said.
The MPs revealed that they have also been officially made aware of some NHIF staff colluding with India-based healthcare providers to siphon off millions through dubious medical claims.
On what NHIF is doing to curb fraud and corruption, Dr Kuhora said: “The introduction of biometric verification has strengthened our authentication processes, ensuring accurate identification of beneficiaries and minimising identity related fraud.”
However, Dr Pukose said that fraud is mostly perpetrated by healthcare providers and not contributors.
Dr Kuhora also admitted that in the last financial year, there were challenges with remittances from the government.
“In terms of premium payment arrangements, we usually have the premiums paid within the first 90 days of the financial year, so within the first quarter we usually assume that the payments have been made. But in the last financial year we had challenges with remittances from government departments and that has led to the accumulation of funds. We have taken a more proactive approach in terms of directly engaging the Principal Secretary Medical Services as well as the Cabinet Secretary for Health to get the funds disbursed as quickly as possible,” he said.
Appearing before the committee as an expert, Kenya Pharmaceutical Distributors Association chairperson Kamamia wa Murichu lifted the lid on how healthcare providers siphon millions from NHIF.
“The hospitals that charge for drugs, which are service providers under NHIF, are grossly abusing the process. They charge exorbitant amounts, two to five times more for the generic version of the drug, but quote the price as what the original version of the drug would cost when they claim money from NHIF,” he said.
“A drug costs Sh600 at the pharmacy level when sold to the patient, but at the hospital, the same drug costs four or five times the usual price and then when the claim is sent to NHIF, it is indicated as the original version of the drug,” he said.
