Health facilities colluded with schools to fleece EduAfya scheme, MPs say

Several health facilities colluded with schools to falsify data on learners seeking treatment under a national cover, leading to possible fraudulent claims, a parliamentary committee has found in its preliminary investigations.

The National Assembly Committee on Health says there has been collusion between some schools and health facilities under the EduAfya insurance scheme.

The team, led by its chairperson, Dr Robert Pukose, found that the number of pupils treated in hospitals did not match the register provided by the respective schools' guards, or those referred by the schools for medication.

“We looked at the school’s watchman register and found only two where some facilities are claiming they treated 20...in other facilities, we saw data of 47 students and we have realised that some are cooking figures and this amounts to a possible collusion,” the Endebess MP said during a visit to Mediheal Hospital and Fertility Centre in Eldoret as part of an investigative visit to the health facility.

The founder of Mediheal Group of Hospitals is former Kesses MP Swarup Mishra.

The committee says it is inspecting selected health facilities in Uasin Gishu County. On Friday, it will conduct an inspection visit to Moi Teaching and Referral Hospital (MTRH).

Pukose was accompanied on Thursday's visit to Mediheal Hospital by other members of the House team, namely Martin Owino (Ndhiwa), Julius Sunkuli (Kilgoris) and Joshua Oron (Kisumu Central).

The House committee began its investigations last year following a Nation expose on how some health facilities colluded with NHIF officials to submit fraudulent claims.

“We have visited select facilities that had received huge millions from the Fund, whether received properly or fraudulently. When we visited some facilities, they closed and ran away and some even shut down. We want to know if you have to wait until a committee visits so that you close,” Pukose said.

Auditor doctored a report

“We were informed that an NHIF auditor doctored a report for the neighbouring facility and we heard that Sh4 million exchanged hands to doctor the report on NHIF claims...as an auditor, one is supposed to do a proper report and this amounts to abuse of office.”

Pukose revealed that the report will be tabled in parliament in the next two weeks when MPs resume from their long recess.

“We hope to finalise and table our report when the House resumes from recess with our recommendations for possible prosecution and the Directorate of Criminal Investigations and the EACC to take over the matter. This report will be debated before the House and MPs will make their decision,” said Pukose.

The team visited selected health facilities in Nairobi, Kirinyaga and Nakuru counties to ascertain whether the facilities that received millions of shillings actually received the money from the Fund.

Sunkuli also questioned how the health facilities they visited were given different statuses ranging from level 1 to level 5.

“We are wondering how some health facilities acquired Level 4 or Level 5 status, yet if you look at them, they don’t qualify for that particular status,” he said.

Meanwhile, Pukose said Kenyans will continue to contribute to the NHIF, noting that the deadline is December.

"We have a transitional clause that allows Kenyans to contribute to NHIF for one year. The NHIF fund will cease operating in December this year when the Social Health Insurance Fund (SHIF) will take over. A transition committee to handle the transition from NHIF to SHIF was announced this week," said Pukose.

However, speaking at a function in Elgeyo Marakwet last weekend, Health Cabinet Secretary Susan Nakhumicha revealed that Kenyans will start contributing to SHIF this month once the public participation forums are completed in two weeks' time.

[email protected]