Hospitals contracted with the government insurance have been exposed following the National Health Insurance Fund (NHIF) Audit.
NHIF says although it's keen on offering services to its members, it has become more stringent before accrediting any new facility.
Audit details reveal mischievous actions by contracted hospitals to defraud the insurance fund through fake claims.
Peter Kamunyo, the chief executive of NHIF, stated, “We had noted some unscrupulous activities where a hospital is captured that it has operating theatres or 100 beds when actually on the ground there is no theatre and even beds are less than 20 beds.”
Though the initiative is up and running, users have expressed displeasure with over 800 hospitals under the Rural Private Association. NHIF has sued some of the health facilities.
Subscription to the service has seen an upward trajectory since its launch by the government. As of the year 2017, new members enrolled in the healthcare services were 4,281 which closely doubled to 8,189 as of June 2020.
This saw a rise in the amount of money collected by its members by the end of the financial year of 2020.
The amount collected from its pool of 8.9 million members was Ksh59.5 billion, while the running cost accumulated to Ksh54.9 million to the hospitals.
The fraudulent activities saw the amount of money claimed by the hospitals shoot from 10 percent to 30 percent.
This is after the contracted hospitals took advantage of loopholes to steal money through fake claims on surgeries and in-patient beds capacity.
Speaking on the matters, Dr. Kamunyo indicated, “We now have a team of assessors who are going around to ensure there is a tally between what the hospital claims to have and the real capacity.”
The state-controlled insurer has also installed a new e-claims system to help fight off fraud activities.
