NHIF saves Sh1.9bn after hospitals’ fraud crackdown

NHIF chief executive Geoffrey Mwangi. file photo | nmg
NHIF chief executive Geoffrey Mwangi. file photo | nmg 

The National Hospital Insurance Fund (NHIF) has saved Sh1.9 billion after a crackdown on hospitals making fake claims.

It paid Sh11.6 billion for the six months to December from Sh13.5 billion in the first half of 2017.

The fund in its latest financial report links the drop to increased scrutiny of claims.

“The efforts of pre-authorisations and added internal controls have seen claim reduction. The benefit payments that majorly declined were inpatient and surgeries,” NHIF chief executive Geoffrey Mwangi says in the Fund’s 2017 performance report.

The NHIF in 2015 introduced outpatient cover and enhanced benefits for ailments such as cancer and major surgeries as well as kidney dialysis after raising the amount that workers contribute to the fund from Sh320 to a graduated scale of between Sh500 and Sh1, 700 per month.

This opened way for hospitals to inflate costs and bill NHIF for procedures not performed.

For instance, hospitals would bill the fund for three dialysis sessions yet it performed one or charge for Caesarean-section births for normal deliveries that costs Sh20,000 less.

There were also cases of impersonation and hospitals launching claims with the intention to defraud the NHIF using members’ cards without their consent.

Mr Mwangi reckons the “introduction of second tier scrutiny of claims” has substantially cut fraudulent claims.

Its inpatient bill dropped to Sh5.9 billion from Sh6.7 billion.

Procedures where hospitals must send a pre-authorisation request through an online platform for specialised services have been increased.

The NHIF also roped in detectives from the Directorate of Criminal Investigations to look into the fictitious claims, which led to some hospitals being removed from the scheme.

Now, the fund is turning to the use of fingerprints to identify its more than seven million members in the battle against fraudsters.

It will start biometric registration where it will capture details of members and their dependents including fingerprints, names and pictures.

Currently, members and their dependents are required to produce the NHIF card and Identification card before receiving services.