Economy

Governors want tougher jail terms for NHIF fraud

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Council of Governors (CoG) Chairperson H.E Martin Wambora addressing Journalists after a full Governors Council meeting at Delta Corner Westlands, Nairobi on October 18, 2021. PHOTO | LUCY WANJIRU | NMG

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Summary

  • The county chiefs in a memorandum to the Senate proposed to more than double the jail term from the current two years passed in a Bill that seeks to amend the National Hospital Insurance Act of 1998.
  • Impersonation involves NHIF members giving their cards to patients not eligible for treatment using the State insurer’s services and hospitals and lying about their bed numbers.

The Council of Governors has petitioned the Senate to increase the jail term for persons found impersonating National Hospital Insurance Fund (NHIF) beneficiaries to five years, in a bid to protect the State-backed insurer from losses linked to fraudulent claims.

The county chiefs in a memorandum to the Senate proposed to more than double the jail term from the current two years passed in a Bill that seeks to amend the National Hospital Insurance Act of 1998.

The proposed changes to the NHIF (Amendment) Bill 2021 are aimed at curbing fraudulent and fictitious claims from individuals and hospitals that cost the State-backed insurer Sh16.5 billion annually.

Impersonation involves NHIF members giving their cards to patients not eligible for treatment using the State insurer’s services and hospitals and lying about their bed numbers.

Governors defended the push to increase the jail term, saying the Bill that was passed by MPs last month has gaps in some of its new provisions.

“Whereas the NHIF Amendment Bill seeks to provide a mechanism for managing health insurance towards the attainment of the universal health coverage, it raises or avoids fundamental issues and recommendations,” said the governors in the petition.

The push to tighten the noose on NHIF impersonators comes at a time the State insurer has said fraudulent claims are on the surge.

Fraudulent NHIF claims usually involve forgery of documents, specifically MRI and CT scans. This has been rampant due to a lack of biometrics to identify members and their dependents.

In May, the NHIF flagged claims forwarded by a hospital in Nairobi involving a woman who tried using her daughters’ card to claim services worth Sh1.246 million, highlighting the gravity of fraud on the State-backed insurer.

MPs had while approving changes to the NHIF Act of 1998 increased the jail term from one year to two years.

The State had pushed for a jail term of three years and a Sh10 million fine or both for those found guilty of impersonation in the wake of NHIF’s increasing losses.

Senators will consider the proposal and return the Bill to MPs for concurrence before the president signs it into law.

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