NHIF loses Sh20 billion through fake claims

By Peter Ochieng

The National Hospital Insurance Fund (NHIF) has lost Sh20 billion through fake claims and fake surgeries orchestrated by various healh facilities across the county.

Susan Nakhumicha, Cabinet Secretary (CS) for health on Friday lifted the lid on the scandal which may have a long time negative impact on the health insurance scheme.

The CS said that out of 67 audited hospitals in the country, 27 had been suspended over the loss of the money, through dubious NHIF claims and acts.

“Between January and December 2023, out of 67 audited hospitals, 27 were found to be involved in fraudulent activities," stated the CS during a press briefing.

“Extrapolating this to the total population of 8,886 hospitals, it is estimated that approximately 3,440 might have been engaged in fraudulent activities, potentially exceeding Sh20 billion in losses from about 40% fraudulent hospitals. Luckily 60% carry out clean business.”

The CS said investigations were carried out by the newly unveiled Social Health Authority (SHA), adding that they have initiated a process to ensure the lost money is recovered and returned to NHIF.

The ministry also discovered anomalies whereby facilities with a theatre capacity of conducting only two eye surgeries in a day, some hospital were conducting about 10 to 22 surgeries.

She said that in itself raises questions on the legitimacy of claims, and the resources available at the said facilities.

In addition, the CS said the ministry also uncovered another fraud involving the EduAfya cover, where healthcare facilities were found to have been enticing healthy students and providing them with food incentives for their biometrics, thereby resulting in high financial losses.

“Additionally, cases involving nurses stationed in schools collecting biometrics of non-ill students to lodge fictitious claims have been unearthed, significantly exploiting the scheme,” she revealed.

The suspended hospitals include Jekim Hospital Meru, Jekim Medical Centre, Joy Nursing & Maternity, Amal Hospital Ltd, Beirut Pharmacy and Medical Centre, St. Peter’s Orthopedic and Surgical Specialty, Afya Bora Hospital Annex Ltd in Mwea, Charity Medical Centre, Queens and Kings Hospital, Chest & Skin Clinic and Kiritiri Medical Healthcare.

Others are Meswo (Tunza) Medical Services, Familia Bora Medical, Naivasha Quality Healthcare, Bingwa Family Clinic, Elburgon Nursing Home, Nyamira Jamii Medical, St. Joseph Shelter of Hope, Lenmek Hospital, Equity Afia Buruburu, Murang'a High School Dispensary, Mathingira Medical Centre, Ruai Medical Centre and Thuti Medical Clinic.