A parliamentary committee has initiated an inquiry into allegations of fraud in the payment of claims and irregular tendering processes at the National Health Insurance Fund (NHIF).
The inquiry by the Health Committee of the National Assembly comes against the backdrop of NHIF’s failure to remit capitation to hospitals which provide services to its card holders and claims of collusion among some senior NHIF officers and owners of private health facilities to swindle the public insurer.
There is also the refusal of hospitals across the country to accept NHIF cards from Kenyans seeking treatment, subjecting them to untold suffering.
Yesterday, Medical Services Principal Secretary Harry Kimtai, under whose State department lies the public insurer, NHIF acting CEO Samson Kuhora and board chairman Michael Kamau, could not disclose to the committee how much the fund rakes in annually in statutory and voluntary contributions, penalties and from those who pay in advance.
The failure to disclose the figures and the sketchy responses to members’ questions forced the committee to launch investigations to get to the bottom of the matter.
Dr Robert Pukose, the committee chairman, said Kenyans cannot continue to suffer as the House team watches.
“When we call for an inquiry of this kind, we want to get to the bottom of the issues affecting the public insurer and see how we can have them solved to ease the burden on Kenyans. We will ensure that NHIF delivers the Universal Health Coverage, which is its core mandate,” said Dr Pukose.
He spoke as Mr Kimtai promised full cooperation with the committee as it undertakes the investigations.
“The loopholes at NHIF can be identified by this committee. We are ready to provide all the required information to this committee,” said Mr Kiptoo after the committee said the information provided by Dr Kuhora was inadequate.
But what shocked members of the committee is the fact that NHIF cannot pay for the treatment of its card holders yet it has a surplus of Sh6 billion in the current financial year, with over Sh37 billion as reserves in various bank accounts.
Dr Pukose, who is also the Endebess MP, demanded to know whether NHIF senior management is colluding with owners of some private hospitals to fleece Kenyans.
For instance, the document NHIF presented to the committee shows that as at June 15, 2023, Sh9.5 billion was spent by the public insurer as payment on EduAfya , Linda Mama maternity cover and rebates.
Out of this, about Sh5 billion went to private hospitals, Sh3.3 billion to government institutions and Sh1.3 to mission facilities.
“Many patients are going through so much frustration. They are not accessing services with NHIF cards. When they go to health facilities they are turned away yet some private hospitals are promptly paid huge amounts, with others not paid for years,” the Endebess MP said.
The committee was also not impressed after Mr Kuhora failed to provide NHIF’s cash flow statements for the past two years and its financial reserves and reserve policy.
Nyeri Town MP Duncan Mathenge could not understand why the public insurer cannot pay for services offered to its members yet it continues to collect money from Kenyans every month.
“The NHIF card holders want to know why they cannot be catered for yet their money has been deducted,” said Mr Mathenge, noting that NHIF declined to settle the medical expenses of his own mother who is undergoing cancer treatment in the country.
