Revealed – NHIF Paying out Millions in Fake Claims

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Chrispen

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In a new audit report confirmed by the insurer, many hospitals in the country which are contracted by the State to offer NHIF services have been hiking claims after producing unauthentic facility standards to paint a picture of a fully equipped hospital when in real sense they are not.

Fresh audit details have revealed worrying state of affairs where almost all private facilities have been defrauding the insurance fund through cooked up claims.

“We had noted some unscrupulous activities where a hospital is captured that it has operating theaters or 100 beds when actually on the ground there is no theater and even beds are less than 20 beds,” Peter Kamunyo, the chief executive at NHIF, stated.

Currently, NHIF is in the process of weeding out such unscrupulous players and suing some to clean up the mess that has for decades frustrated health service delivery fin the country.

Almost every after two years, NHIF members have been forced to double their subscription what still has never brought any meaningful change. As of the year 2017, new membership was established to be at 4,281 which went up to 8,189 by June 2020.

In essence, this increased NHIF collections by the end of the year 2020. Unfortunately, this monies were still not enough to offer comprehensive medication for its members.

And according to fresh reports, fraudulent claims saw NHIF lose a whopping 30 percent instead of the normal 10 percent of their total sh 59.5 billion collections

It is reported that the contracted facilities have been colluding with some officials in the institute to make falsely assessed claims by taking advantage of the many available loopholes.

“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,” Dr. Kamunyo indicated.

They have also installed a new e-claim system to reduce such cases of stealing.