National Assembly's Health Committee Probes Fraudulent Payment of NHIF Medical Claims

National Assembly’s Departmental Committee on Health met the National Health and Insurance Fund (NHIF) acting CEO Samson Kuhora on fraudulent payment of medical claims at NHIF. The National Assembly Committee on Health is probing the alleged fraudulent payments of medical claims and capitation payments to health facilities by NHIF.

Moyale MP Prof. Jaldesa Guyo Waqo pressed Dr Kuhora to shed light on how dubious claims were generated and paid without the NHIF doing due diligence.

“All that we are investigating lies with the CEO and he needs to come clear on the facilities that were charging twenty or more times than the approved rate,” said Hon. Guyo.

The MP also alleged that before Dr. Kuhora’s promotion three months ago he was working in a department where he allegedly aided the fraud.

“I feel like you might have been elevated to acting CEO to conceal what you have been doing, unless you prove otherwise, in your position three months ago, what we are investigating is what you were doing before being elevated,” he said.

The CEO however refuted the claims saying that NHIF had already taken action by suspending contracts with six hospitals for 90 days.

Kuhora revealed that investigations into Beirut Pharma and Amal Hospital in Eastleigh had been completed and it was established that they had been involved in fraud. For the other six facilities, he said, investigations are still ongoing with a report expected within three months from July 16.

At the same time, it has emerged that NHIF made losses amounting to approximately Sh6 billion due to the non-remittance of premiums by the government.

Finance officer at NHIF Francisca Mwanza told the committee that the funds’ claims reserves had decreased from Sh15 billion in 2021 to Sh8 billion in 2023. This, she explained, was a result of the decline in investments due to a delay in remittance by the national and county governments.

Seme MP Dr James Nyikal faulted NHIF for giving government institutions services on credit which he said was sinking the fund.
“Isn’t it discriminatory and against the law that when voluntary NHIF contributors default on payment you not only deny them services but also penalize them yet for government schemes you allow them to operate on credit?” asked Dr Nyikal.

The acting CEO however noted that the same was in line with contractual agreements between the fund and both levels of government.

Dr Kamamia Murichu, the chairman of Kenya’s pharmaceutical distributor’s association, testified before the Committee, calling for NHIF to employ pharmacists and clinical officers to oversee and ensure the legitimacy of claims and curb fraud.

The committee is expected to continue with the probe with the Health Cabinet Secretary and his principal scheduled to appear before it.