Health CS admits fraud at NHIF through fake claims by hospitals

Health Cabinet Secretary Susan Nakhumicha at Lugulu Mission Hospital on January 2, 2024. [Nathan Ochunge, Standard]

Health CS Susan Nakhumicha has acknowledged a significant financial fraud within the National Health Insurance Fund, with private hospitals allegedly submitting counterfeit claims, leading to the embezzlement of billions of shillings.

Nakhumicha said: "The claim records received by the Ministry from private hospitals unmistakably reveal extensive fraud, perpetrated through the issuance of fabricated patient records."

She expressed concern, noting, "We have encountered substantial fraudulent activities where private hospitals have illegitimately obtained funds from NHIF, presenting fictitious claims without genuine medical justifications."

During her visit to Lugulu Mission Hospital in Bungoma County, Nakhumicha issued a stern warning to hospitals, cautioning against inflating NHIF bills through the fabrication of patient records.

She shared an alarming example, saying, "We have encountered cases where individuals claim to have undergone left leg amputations three times. It raises questions when a leg supposedly grows back, only to necessitate another amputation."

Asserting her commitment to addressing the challenges within NHIF, Nakhumicha said, "NHIF faces numerous issues, but I am currently overseeing the ministry and actively addressing the perpetrators.

"My role is akin to goal-keeping; I am ensuring no one scores against the national health insurer by illicitly siphoning funds earned through the hard work of Kenyan citizens."

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Nakhumicha said the Health ministry had received one billion shillings from the treasury, saying the funds "will be allocated to compensate Community Health Promoters (CHPs) every month for the next three years."

She said, "All CHPs have been equipped with smartphones to record details of the patients they attend to, along with the specific ailments addressed, and transmit this information directly to Afya House."

Nakhumicha expressed frustration over delays caused by "many court cases," hindering the discharge of her duties.

She said, "These legal disputes are impeding the implementation of laws aimed at extending universal health coverage to all Kenyans."

Addressing the Critical Illness Emergency Fund, she said it would cover treatment expenses for individuals with chronic diseases such as cancer, diabetes, and hypertension.

In a plea for support, Nakhumicha said, "Pray for me, President William Ruto, and the judges presiding over the numerous court cases to expedite the resolution, allowing me to commence my work."

She added, "Last year, we laid the foundation as a ministry; this year, we are actively implementing our plans."

Nakhumicha's acknowledgement comes in the midst of a dispute between the NHIF and certain private hospitals engaged in a contentious blame game regarding allegations of fraud.

In the previous month, the senior management of NHIF informed the Senate Health Committee that "there has been collusion between a section of its staff and some private medical facilities" in the ongoing controversy.

The NHIF disclosed to the senators that "they have uncovered significant fraud involving at least 20 private facilities in the past year," resulting in the suspension of operating licenses for some of these facilities.