Editorials

NHIF needs to clean up its own house in fraud fight

nhif-biometrics

A member of the public scans his finger during NHIF mass biometric registration in Nyeri County on June 2, 2021. FILE PHOTO | NMG

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Summary

  • The rise in false claims from the National Hospital Insurance Fund (NHIF) is part of the reason the State insurer has been struggling to meet its obligations to the millions of Kenyans who depend on it to meet their healthcare costs.
  • The problem is far-reaching, involving not just hospitals, but also unscrupulous officials at the insurer who abet the vice.
  • The Sh16.5 billion lost through false claims is enough to cover the cost of treatment for many of the chronic illnesses that are leaving families penniless.

The rise in false claims from the National Hospital Insurance Fund (NHIF) is part of the reason the State insurer has been struggling to meet its obligations to the millions of Kenyans who depend on it to meet their healthcare costs.

The problem is far-reaching, involving not just hospitals, but also unscrupulous officials at the insurer who abet the vice.

The Sh16.5 billion lost through false claims is enough to cover the cost of treatment for many of the chronic illnesses that are leaving families penniless.

For instance, the amount is enough to cover the annual dialysis costs for 33,000 patients, at a cost of Sh9,500 per week each.

It can also pay for cancer treatment and allow the insurer to play its rightful role in helping Kenya achieve her dream of universal healthcare for all.

The current penalties against those hospitals caught defrauding NHIF amount to a mere slap on the wrist, given the huge volumes that these institutions earn from providing healthcare to Kenyans. A fine of Sh500,000 would unlikely deter a hospital from taking a risk and padding its claims, especially with the accompanying ban from the State insurer stipulated as not exceeding five years.

It is therefore refreshing to see that the NHIF management is finally taking concrete steps to address the problem through the proposed permanent ban for hospitals caught cheating.

Such a move will see patients vote with their feet against the offending institution.

However, this by itself is not enough if the health insurer does not take similarly drastic measures to clean up its own house and weed out any staff who either help the rogue hospitals cheat or fail in their duty to prevent abuse of contributor funds.

Similarly, in order to discourage individuals who fraudulently use the scheme to settle their bills—which is at the expense of other equally deserving cases— the law should also spell out punitive measures to deal with such people.

Otherwise, a blanket promise to ban hospitals will be seen as just another proclamation by the insurer and embolden the culprits to go on with their illegal activities.