Insurers ditch Nairobi Women’s Hospital following cost inflation scandal

One of Nairobi Women’s Hospital branches at Adams Arcade, Nairobi. Photo/Courtesy

Health insurers in Kenya have severed ties with the Nairobi Women’s Hospital following a damning exposé that revealed a widespread conspiracy to inflate patient bills and prolong admissions unnecessarily. The drastic decision follows the publishing of a number of Whatsapp messages from the hospital’s staff group on Twitter by @Owaahh.

In the leaked messages from Nakuru Hyrax branch WhatsApp group, immense pressure is seen to be put on doctors working at the establishment by their superiors to prolong the admission of patients to meet hourly, daily and monthly financial targets. In some instances, doctors were given a few hours to meet their patient number targets by the chief executive officer of the Nakuru Hyrax branch, Dr Felix Wanjala. They also show how the revenue, commissions, admissions and discharge numbers were actively monitored throughout the day and night by Dr Wanjala.

Doctors who failed to meet targets or seemed to discharge patients too soon would be reprimanded on the group and asked to ‘manage’ their patient numbers. In one message, the hospital’s COO, Eunice Munyigi, admonishes a doctor for discharging too many patients. Her message read, “Ruku, yesterday you discharged 14, today planned 12, this is not sustainable. Urgently fix. 🙋‍♂️” In yet another message on the group, she writes, “Victoria 13 discharges are many kindly manage.”

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The branch’s CEO also participated in hounding doctors about their patient admission numbers. In one message on the Nakuru group, he wrote, “how did we end up at 18 discharges from 10 planned. 😕”

From forwarded messages captured in the leaked screenshots, it is apparent that the hospital, which has nine branches across the country, tracked targets cumulatively and in each of the branches. Pressure was then exerted at branch level to increase revenue by any means.

Following a special meeting held on Monday evening, the Association of Kenya Insurers (AKI) decided that the underwriters would not honour any claims from the hospital. Subsequently, UAP Insurance, AAR Insurance, CIC Insurance and Old Mutual released their own statements confirming the suspension of their services as of 5th February to the medical services provider pending resolution of the scandal. Insurers account for the largest proportion of the hospital’s revenue, as high as eighty per cent in some branches.

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In response to the allegations, the hospital issued a statement on Tuesday, 3rd February, promising to conduct an internal investigation and cooperate with an investigation being carried out by the Kenya Medical Practitioners and Dentist Board.

The statement read, “… we have noted with a lot of concern reports appearing in various media platforms in the recent past suggesting that there is some systematic approach by the hospital to unfairly generate revenue from patients. Although we don’t believe this is the case, and in fact it is antithetical to our foundational principles, we take these allegations very seriously and are conducting an internal review as well as cooperating with the Kenya Medical Practitioners and Dentist Board as they carry out their independent review.”

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Through its chairperson, Dr Eva Njenga, the medical board said that they would reveal their findings on the hospital’s conduct within a month.

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