MPs are probing how the National Health Insurance Fund (NHIF) paid out Sh9 billion in Work Injury Benefit Act (Wiba) premiums to insurance companies but only used Sh200 million to settle patients claims in the last two financial years.
During grilling of NHIF CEO Samson Kuhora, the legislators yesterday alluded to the possibility that some rogue staff conspired with the insurance companies to swindle Kenyans of their money.
The National Assembly Health Committee also sought to know why the Fund had elected to pay such high premiums at the expense of Kenyans.
“It is not practical to be paying Sh9 billion to insurance companies whereas the payout to patients is way less. Clearly the scheme is being used as a cash cow for some people,” said committee chair Robert Pukose.
The committee noted that it was aware of the fraud going on at NHIF and pointed an accusing finger at the Fund’s quality assurance department.
“It is clear that NHIF does not want to expose those involved in fraud and if the committee goes ahead to make its recommendations, then things won’t end well for some people,” said Mr Pukose.
Nyeri Town MP Duncan Mathenge put Dr Kuhora to task to explain why premiums paid out to companies under Wiba had been increasing on a yearly basis in comparison to other schemes by NHIF.
Mr Mathenge noted that there was an increase in claims from Sh833 million in the 2020/2021 financial year, to Sh2 billion in the 2022/2023 financial year and sought clarity on the same.
“We also want to know the measures put in place to reduce the amount in premiums paid to companies because they are proving too costly to Kenyans and beneficial to only a few,” said Mwea MP Mary Maingi.
Dr Kuhora concurred that the payout to patients was low but attributed the increase in payment of premiums to the Covid-19 pandemic during which “the institutions had to support government officers who sought their intervention.”
“The management of Covid-19 is what increased the premiums as we had to support approximately 599,000 workers,” he said.
The NHIF boss, however, came under fire from the committee for allegedly lying under oath. “NHIF did not pay for Covid-19 as this was the prerogative of the government. You cannot continue lying to this committee under oath,” said Pukose.
Meanwhile, the House committee yesterday took NHIF’s top management to task over the planned procurement of a new Sh4.2 billion biometrics system that will see it ditch the current Sh1.6 billion system.
Acting NHIF ICT Director Washington Okoth, however, assured MPs that the system would be upgraded to seal loopholes that had been exploited to commit fraud.