The National Hospital Insurance Fund (NHIF) has closed two hospitals based in Nairobi County temporarily over claims that the facilities have been exploiting elderly patients.
While appearing before the National Assembly’s Health Committee, NHIF Acting Chief Executive Officer Dr. Samson Kuhora noted that apart from the two hospitals, more health facilities are still under investigation and will be brought to book in due course.
He added that there have been several forensic audits to diagnose the root problem.
“The introduction of biometric verification has strengthened our authentication process, ensuring accurate identification of beneficiaries and minimising identity-related fraud,” he uttered.
The National Assembly Committee on Health is probing the alleged fraudulent payments of medical claims and capitation payments to health facilities by NHIF.
The CEO stressed that NHIF had already taken action by suspending contracts with six hospitals for 90 days.
Kuhora affirmed that investigations into one health facility in Eastleigh, Nairobi County had been completed and it was established that senior managers engaged in fraudulent activities.
This comes at a time NHIF is reeling from posting huge losses. In the last financial year, the institution recorded a Sh6 billion loss which was attributed to the non-remittance of premiums by the government institutions.
NHIF Finance Officer Francisca Mwanza told the committee that the losses incurred through fraudulent claims by public and private hospitals had decreased from Ksh15 billion in 2021 to Ksh8 billion in 2023.
“This was a result of the decline in investments due to a delay in remittance by the national and county governments,” she stated.
In the steamy session, the national insurer was also faulted for giving government institutions services on credit which he said was sinking the fund.
The acting CEO however noted that the same was in line with contractual agreements between the fund and both levels of government.
