This archive report was first published on 23 August 2021.
At least Sh16.5 billion is lost annually by the National Hospital Insurance Fund (NHIF) due to fictitious claims from hospitals that have been exaggerating their bed numbers and operating theatre capacity.
The state-controlled insurer has been defrauded by hospitals that have lied about their facilities, with some claiming to have operating theatres when in reality they do not exist.
According to NHIF's chief executive, Peter Kamunyo, the insurer has a team of assessors who are verifying the capacity of hospitals to ensure that there is a tally between what the hospital claims to have and the real capacity.
As of June 2020, the number of healthcare providers enrolled with NHIF had increased to 8,189, up from 4,281 in 2017.
During the year ended June 2020, NHIF collected Sh59.5 billion from its 8.9 million members and paid out Sh54.9 billion or 92.2 percent as claims to hospitals.
Dr. Kamunyo has stated that NHIF has sued several hospitals in the last month and plans to increase surveillance and rely on the e-claims process to cut exposure to fraud.
The inaccuracies had forced NHIF to halt contracting new hospitals, sparking outcry among facilities seeking accreditation.
Published on August 23, 2021.
