Teachers and police officers will now not access medical services in 15 health facilities after an insurance broker terminated and suspended contracts for their covers citing fraud.
Services for teachers have been terminated in eight facilities and suspended in four others while three deals for the security agents have been cancelled.
The insurance company, AoN, has terminated the agreement with Mwea County Medical Centre in Kirinyaga, Meswo Medical Clinic (Nandi), Mother Solbritt Nursing Home (Kuria East), Griftu Nursing Home (Wajir), Mashallah Nursing Home (Wajir), ISMC Clinic and Hospital (Marsabit), Kerugoya Medical Centre (Kirinyaga) and Sofiaz Medical Clinics (Taita Taveta).
Health facilities that have been suspended include Neno Opticians, Sigmart Optical Centre and Crystal Optics in Kiambu County and International Optica in Mombasa.
The insurer revealed that the facilities have been filing claims on patients who were never treated.
The hospitals also sought payment from both AoN and the National Hospital Insurance Fund (NHIF) for procedures only the government body undertakes.
It was discovered that health practitioners had approved medical procedures that were unnecessary on patients who were not admitted in addition to converting primary diseases to chronic illness and treatment mismatch.
The insurer has since lodged various complaints with the Insurance Regulatory Authority (IRA) and taken action with individual teachers and police officers who intiated the fraudulent scheme.
"In the case of client-initiated fraud, the matter has been taken up with the employer," a report by the insurer stated.
