A parliamentary committee has opened an investigation into claims that the National Health Insurance Fund (NHIF) engaged in fraudulent claim payments and irregular tendering procedures.
The National Assembly’s Health Committee is looking into the matter in light of the fact that the National Health Insurance Fund (NHIF) has allegedly colluded with the owners of private healthcare facilities to defraud the public insurer by failing to pay capitation to hospitals that provide services to its cardholders.
In addition, hospitals all over the nation refuse to accept NHIF cards from Kenyans seeking medical care, causing them untold suffering.
The amount of statutory and voluntary contributions, penalties, and payments in advance that the fund receives annually could not be disclosed to the committee on Tuesday by Medical Services Principal Secretary Harry Kimtai, whose State department oversees the public insurer, acting NHIF CEO Samson Kuhora, and board chairman Michael Kamau.
The committee launched investigations to find out the truth because the numbers were not disclosed and the answers to the members’ inquiries were evasive.
The committee chairman, Dr. Robert Pukose, stated that Kenyans cannot continue to suffer while the House team watches.
“When we call for an inquiry of this kind, we want to get to the bottom of the problems affecting the public insurer and figure out how to solve them so that Kenyans are not burdened.” “We will ensure that the NHIF delivers on its core mandate of universal health coverage,” said Dr Pukose.
He spoke as Mr. Kimtai promised full cooperation with the committee as it conducts its investigations.
This committee is able to pinpoint the NHIF’s flaws. After the committee stated that the information provided by Dr. Kuhora was insufficient, Mr. Kiptoo stated, “We are prepared to provide this committee with all the necessary information.
Members of the committee were shocked to learn that NHIF cannot afford to treat its cardholders despite having a surplus of Sh6 billion and over Sh37 billion in reserves across numerous bank accounts in the current fiscal year.
Dr. Pukose, who is also the MP for Endebess, demanded to know if the senior management of the NHIF is working together with the owners of some private hospitals to defraud Kenyans.
According to the document NHIF presented to the committee, as of June 15, 2023, the public insurer had spent Sh9.5 billion on EduAfya, Linda Mama maternity cover, and rebates.
Sh5 billion went to private hospitals, Sh3.3 billion to government institutions, and Sh1.3 billion to mission facilities.
“There are many patients who are extremely frustrated.” They are unable to use NHIF cards to access services. When they go to health facilities, they have turned away, despite the fact that some private hospitals are paid quickly, while others are not paid for years,” Endebess MP said.
The committee was also unimpressed when Mr. Kuhora failed to provide NHIF’s cash flow statements for the previous two years, as well as its financial reserves and reserve policy.
Duncan Mathenge, MP for Nyeri Town, could not understand why the public insurer could not pay for the services it provided to its members while continuing to collect money from Kenyans every month.
“The NHIF cardholders want to know why they can not be catered for but their money has been deducted,” Mr. Mathenge said, noting that NHIF refused to pay for his mother’s cancer treatment in the country.
MPs also questioned why the NHIF is so involved in commercial insurance.