By Ebi Kesiena
The Kenyan Government has suspended 27 hospitals for allegedly being involved in fraudulent activities that resulted in a loss of Sh171 million of the government insurance fund.
According to the Health Cabinet Secretary, Susan Nakhumicha, these facilities were among 67 hospitals that were audited between January and December 2023.
In a statement to media houses on Friday, the CS noted that the 27 facilities have been making fraudulent claims from the National Health Insurance Fund (NHIF), which was recently replaced by the Social Health Authority.
“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 per cent fraudulent hospitals. Luckily 60 per cent carry out clean business.
“The widespread nature of these alleged fraudulent cases is deeply concerning. The list of implicated facilities includes instances of induced demand, particularly targeting vulnerable citizens, notably older individuals,” she stated.
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She explained that patients have been enticed into unnecessary medical procedures, exploiting their vulnerabilities.
Furthermore, the CS explained that instances of induced sickness have been uncovered, wherein facilities deceitfully activate dormant accounts of members, financing medically unwarranted treatments.
She added that fictitious records, manufactured claims, and deceptive practices, such as falsely indicating members undergoing major surgeries while actively at work, have all contributed to allegedly defrauding the Fund.
“Disturbingly, some hospitals have targeted groups of security guards from licensed security firms, financially inducing them to provide biometrics for alleged fraudulent purposes,” she stated.
The CS maintained that anomalies were also identified, including facilities conducting an exceptionally high number of eye surgeries in a day, ranging from 10 to 22, in facilities with a capacity of only two per day, while lacking adequate theatre capacity.
Nakhumicha said the Authority is determined to reduce and eliminate alleged fraud by automating services to minimise human interface.
She said the ICT systems are intended to have strong business intelligence modules to be able to flag outliers and double payments in time.
However, the CS assured that the government, in collaboration with relevant stakeholders, to ensure those responsible for reprehensible actions are brought to justice.
“As we collectively tackle this crisis, we reaffirm our commitment to fortifying and safeguarding the integrity of our healthcare system,” she said.
