Private hospitals have threatened to stop treating police and prison officers under the Medical Administrators Kenya (MAKL) scheme over an outstanding insurance debt of more than Sh2 billion.
In a May 20, 2024 letter to the scheme administrator, and CIC (the former lead insurer), Rural and Urban Private Hospitals (Rupha) has accused the administrator of withholding up to Sh2.58 billion.
This is despite the Treasury and the National Police Service Commission (NPSC) having disbursed the full contractual amount for January to December 2023.
Rupha, which is the contracted healthcare provider for the police has accused MAKL of breaching the contract by failing to make timely payments for services rendered.
The money goes from the Treasury to the NPS, then to the CIC, to Bliss Healthcare Kenya (the master payer) which makes the final disbursements to the hospitals through MAKL.
Brian Lishenga, chairman of Rupha, has demanded that the administrator pay outstanding claims for the past eight months or the beneficiaries pay in cash.
"In view of the above revelations and the clear and persistent breach of contract on your part, we are issuing this formal notice on behalf of the contracted healthcare providers demanding settlement of all outstanding claims from July 2023 to 31 March 2024 within 10 days of receipt of this letter.
"Failure to comply with this notice will leave us with no option but to ask beneficiaries of the medical scheme to make out-of-pocket payments in order to access necessary health services," said Dr Lishenga.
The move follows the confirmation that the Treasury and NPSC have released the funds in nine instalments from March 17, 2023, with the last instalment of Sh750 million disbursed in February 2024.
According to Rupha, the last payment to providers by MAKL was made in January 2024 for claims incurred in June 2023.
