Insurance firms reinstate credit services at Nairobi Women's Hospital

The Association of Kenya Insurers has reinstated the services of Nairobi Women’s Hospital and all its satellite branches.   The move followed an extensive engagement between the hospital and insurance companies which led to a consensus.   In a press statement released on Monday, the association reinstated the services suspended on February 5.   At the same time, Jubilee Insurance further stated that credit services at Nairobi Women’s Hospital and all its branches have been reinstated effective April 16.   The Hospital’s troubles began when medical officers were accused of recommending unnecessary laboratory tests, admissions and delayed patients’ discharge to maximise revenue, leading three AAR insurance Limited, UAP Old Mutual Group and CIC General Insurance Limited to suspend their services at the facility.   Other insurance firms later followed suit.   At the time, UAP Insurance warned its customers that even cash payments to the hospital may not be eligible for reimbursement.   “Even cash payments to the hospital may not be eligible for reimbursement. We request you to seek services from alternative hospitals in our provider panel,” said UAP in a statement.   Kenya Revenue Authority also suspended the facility from its list of approved medical care providers.   The claims emerged after screenshots of conversations claimed to be from a WhatsApp group of Nairobi Women’s Hospital staffers were exposed online.   The accusations led the CEO Felix Wanjala to step down to allow for investigations into allegations of fraud at the facility. This led the institution’s board to appoint an Operating Committee on an interim capacity to run it.   According to Amnesty International's Houghton Irungu, the crisis also offers insight into why the medical insurance industry is struggling. If the bloggers, health rights activists and investigative journalists are courageous enough to dig more comprehensively, they will reveal how predatory healthcare has become.   There are at least six ways to defraud citizens, health insurance companies and the government.   They include billing for services not rendered, inflating costs, filing duplicate claims, unbundling and staggering billing to avoid scrutiny, offering unnecessary services and kickbacks for medical professionals to use more costly services.   These practices have bankrupted families, defrauded insurance agencies and torpedoed the Jubilee Administration’s commitment to universal health coverage.