Jan, 7th 2021 – The National Hospital Insurance Fund (NHIF) has flagged hospitals in Nyamira, Homa Bay and Migori counties that were involved in various forms of fraud.
A memo from the national insurer has shown that most of the facilities have been flagged for possible fraudulent surgical procedures and claims. A facility in Nyamira County, was found to employ non-licensed health professional staff, as well as taking part in falsified admissions.
NHIF has mentioned unnecessary surgeries as the top form of fraud having paid sh6.9 billion for the claims, with sh5.6 billion settling major surgeries and a further SH610 million on specialized surgeries in A hospital in Migori county.
The Insurer, in 2017, said that it had invited detectives from the Directorate of Criminal Investigations (DCI) to inquest the loss of up to sh500 million every month through fictitious claims.
By February 2020, Insurance companies had placed more private hospitals under surveillance due to the inflated bills. After many insurance companies severed ties with private hospitals, the Kenya Insurers Association (AKI).
The insurer now blames the increase in fictitious claims, on collusion between a section of the Fund’s employees and some hospitals.