Hospitals face probe over ‘NHIF fraud, malpractices’
The National Health Insurance Fund headquarters in Nairobi.
MPs on Monday questioned eight institutions linked to fraudulent activities aimed at collecting unjustified claims from the National Health Insurance Fund (NHIF).
This follows an exposé carried out by Nation in June. The national Assembly Committee on Health also questioned the facilities about their involvement in the setting up of medical camps to attract patients.
Some of the hospitals allegedly used the Edu Afya student programme to make money illegally. Jekim Medical Centre, a Level Two hospital in Nkubu, Meru County, was accused of receiving an inflated amount of about Sh1.54 billion from the NHIF.
It is one of the hospitals that Health Cabinet Secretary Susan Nakhumicha ordered closed following the NTV exposé.
However, the hospital resumed operations on August 18.
Ms Wendy Marete, the hospital’s administrator, denied any involvement in organising the medical camps.
The hospital has also been accused of transporting students from school to its facility in order to claim money under the Edu Afya insurance scheme.
The audit report submitted to the Health Committee shows that around 3,000 students were treated at the hospital during the period under investigation.
Of the 21 students interviewed, 15 admitted that they had been provided with transport to the hospital and snacks. The committee was also privy to printed discharge slips bearing the name of the hospital.
“We have no control over where these students go for medical attention; probably [ they come because of] our good service. We did not distribute snacks or transport the students,” Ms Marete said.
However, Dr Robert Pukose, chairman of the committee, noted that the hospital had used incorrect codes to submit claims to the national insurer.
He also mentioned that about 20 records were also not available but payment had been made.
Ms Marete acknowledged the erroneous claims that were filed due to wrong codes, but did not confirm whether the money received by the hospital would be paid back to the NHIF.
A sister hospital, Jekim Hospital Nkubu Limited, was found to be non-compliant with its status as a Level Four facility. The committee found that it lacked most of the equipment and staff required. Dr Pukose also mentioned that the report showed that the NHIF incurred a loss of Sh4.7 million as a result. There was another financial loss of about Sh262,000 from 20 unjustified admissions.
“I was not aware that money was lost. The doctors discharge patients when their conditions improve. We have never run a medical camp,” said Ms Edith Gatwiri, the hospital's administrator.
The hospital was also found guilty of exceeding the 80-bed capacity stipulated in its contract. However, Ms Gatwiri said the extra beds were part of the government’s Linda Mama initiative.
Afya Bora Hospital in Mwea, which has a branch called Afya Bora Annex and specialises in orthopaedic surgery, was similarly accused of setting up medical camps. Dr Wachira Wagioko, an orthopaedic surgeon, told MPs fraudsters posing as hospital’s staff put up the medical camps.
An audit report presented to the committee shows that the hospital fraudulently claimed about Sh1.79 million for seven magnetic resonance imaging (MRI) scans, even though it does not own an MRI. The hospital also claimed an additional Sh4.5 million for about 20 MRI scans.
The administrator of Afya Bora Annex was grilled over the Sh12,540,000 that was claimed before pre-approval, data that wasn't recorded in the theatre register and late reporting.
The report also shows that 30 of the 31 patients were brought to the facility from various medical camps in Central region.
Dr Wasena Angira, founder of St Peters Orthopaedic and Surgical Specialty Centre, said he had picked up a patient from his home, but it was on humanitarian grounds.
Dr Kennedy Otieno of the now-closed Joy Nursing and Maternity Eastleigh admitted that his facility did not meet Level Four status, despite being classified as such.
Amal Nursing Hospital and Beirut Pharmacy and Medical Centre, represented by their lawyer, Hussein Kusow, said they had taken their case to court, which was why they did not attend the committee hearing.
