NHIF flags rising fraud cases across county hospitals

The National Hospital Insurance Fund (NHIF) has flagged 15 health centres across the country for trying to defraud it of Sh27 million.

NHIF chief executive Peter Kamunyo said the Sh27,271,028 cases were detected between February and March.

One of the top cases involving a facility in Kirinyaga, he added, is currently with the Directorate of Criminal Investigation (DCI) awaiting prosecution.

“We have been experiencing fraudulent cases and attempts worth a lot more which is quite disappointing,” he said.

Dr Kamunyo said that the fraudsters were mostly presenting claims for fake surgeries.

The claims usually involve making of documents, specifically MRI and CT Scans.

One of the claims forwarded by a hospital in Nairobi involved a woman who tried using her daughters’ card claiming services worth Sh1,246,007.

NHIF has blocked the beneficiary and forwarded the case for investigation.

Also in Nairobi, a civil servant attempted to defraud the national insurer of Sh1,000,000 by declar ing her sister as her spouse.

The investigation report was adopted by DCI office on 12/04/2021.

In May, a Kisumu hospital administrators were nabbed after an investigation into forgery of signatures of school principals, revealed that they used fake school rubber stamps, fake birth certificates, and school letterheads to defraud NHIF.

The hospital offers outpatient services for Edu-Afya beneficiaries.

In January NHIF flagged health facilities in Nyamira, Homa Bay, and Migori counties for involvement in various forms of fraud.

The scam involved nine hospitals where healthcare providers claimed to have performed various operations and procedures.

A memo from NHIF shows that most of the facilities were flagged for possible fraudulent surgical procedures and fraudulent claims.

Others were found to be sub-standard and did not meet the minimum threshold for admitting patients.

Fraudulent claims have dogged NHIF for years leading to loss of millions of shillings.

In 2017, the insurer said that it had invited detectives from the DCI to investigate the loss of up to Sh500 million every month through fictitious claims.