NHIF Reforms: Fines to Increase by 20 Times

  • National Health and Insurance Fund (NHIF) Offices Building in Nairobi. Monday, November 18, 2019.
    National Health and Insurance Fund (NHIF) Building in Nairobi. Monday, November 18, 2019.
    Simon Kiragu
    Kenyans.co.ke
  • The  National Hospital Insurance Fund (NHIF) has moved to increase fines against individual contributors and health facilities by up to 20 times.

    Through the National Hospital Insurance Fund (NHIF) Amendment Bill, 2021, the institution has proposed that individuals who obtain benefits through false claims be subjected to a fine of Ksh10 million.

    That is a departure from the current act that provides that the individuals be fined amount not exceeding Ksh 500,000 or imprisonment of 24 months.

    The proposal also increased the imprisonment duration from 24 months to five years.

    A hand holding a National Hospital Insurance Fund card
    A hand holding a National Hospital Insurance Fund card.
    File

    "Section 25 of the principal act is amended in subsection (1) by deleting the words 'a fine not exceeding five hundred thousand shillings or to imprisonment for a term not exceeding twenty-four months, or both and substituting therefore the words 'a fine not exceeding ten million shillings or to imprisonment for a term not exceeding sixty-months, or both." read the statement.

    Individuals who impersonate other people whether living or dead are also liable for the sentence and fines.

    The proposed bill also cautioned hospitals that defrauded NHIF by making false claim noting that they risked "removal from the register of empaneled and contracted health care providers."

    In addition, the health facilities would be subjected to a fine of Ksh10 million, an increase from Ksh 500,000.

    This comes after the institution recorded an increased number of fraudulent activities, mostly from health facilities, involving false claims.

    As recent as January 2021, NHIF flagged a number of hospitals located in Nyamira, Homa Bay and Migori counties for engaging and propagating fraudulent activities.

    The health insurer claimed that some of the hospitals made claims on grounds that they had conducted surgeries when in real sense they had not, all this in an attempt to swindle money from the institution.

    Some of the facilities include Roman Annex Medical Centre at Kemera, Roman Medical Centre at Magombo in Nyamira County and Samjomen Hospital in Migori.

    The proposed bill also encourages individuals aged 18 years that are not dependants of any active member to apply for cover.

    A hospital ward in Kenya
    A hospital ward in Kenya.
    The Standard