Health Cabinet Secretary Susan Nakhumicha has suspended 27 hospitals accused of fraudulent activities that have rendered the National Health Insurance Fund (NHIF) to a loss of Ksh20 billion.
The audit was done on 67 hospitals between July 2022 and June 2023, with the government maintaining that about 3,440 out of 8,886 medical centres defrauded the government.
“The list of implicated facilities includes instances of induced demand, particularly targeting vulnerable citizens, notably older individuals, residing in regions such as Nairobi, Meru, Nyahururu, Muranga, Kerugoya, Makueni, Tharaka Nithi, Subukia, Nanyuki, Bungoma, Chuka, and Machakos," the read part of a statement by the Ministry of Health.
“The widespread nature of these fraudulent cases is deeply concerning," the statement added, further indicating that some hospitals were suspended for three months and others for up to 6 months.
Among the institutions suspended by the CS included Jekim Hospital, Jekim Medical Centre, Joy Nursing & Maternity in Eastleigh, Amal Hospital Ltd, Beirut Pharmacy and Medical Centre, St. Peter’s Orthopedic and Surgical Specialty in Kangemi, Afya Bora Hospital Annex, and Afya Bora Hospital also in Mwea.
Others were Charity Medical Centre, Queens and Kings Hospital, Chest & Skin Clinic, Thuti Medical Clinic, Kiritiri Medical Healthcare, Meswo (Tunza) Medical Services, Familia Bora Medical and Naivasha Quality Healthcare.
Bingwa Family Clinic was suspended alongside Elburgon Nursing Home, Nyamira Jamii Medical, St. Joseph Shelter of Hope, Mathingira Medical Centre, Ruai Medical Centre, Lenmek Hospital, Muranga High School Dispensary and Equity Afia Buruburu.
The Ministry of Health noted that during the investigations, some hospitals were found to have induced sickness while others activated dormant NHIF accounts of members.
Nakhumicha also revealed that under the EduAfya cover, healthcare facilities enticed healthy students, providing food incentives for their biometrics.
Others targeted groups of security guards from licensed security firms, incentivising them to provide biometrics for fraudulent purposes.
"Additionally, cases involving nurses stationed in schools collecting biometrics of non-ill students to lodge fictitious claims have been unearthed, significantly exploiting the scheme," the statement further read.
“Fictitious records, manufactured claims, and deceptive practices, such as falsely indicating members undergoing major surgeries while actively at work, have all contributed to defrauding the Fund,” MoH noted.
