Auditor General: Sh9b was swindled at NHIF

Some Sh9 billion was swindled at the now-defunct National Hospital Insurance Fund last year.

The 2023 Auditor General’s report says NHIF paid Sh9,968,332 for 1,009 duplicates.

The damning report comes at a time when the government is reeling under a backlash by the public over wastage and plunder of national resources, as Kenyans push back on new taxes being imposed by the state.

The national anger that culminated in the breach of Parliament by protesters who were opposed to the now-withdrawn Finance Bill 2024 has brought forth a new debate on the credibility of those mandated with managing national institutions and a push for reforms.

Surprisingly, the claims on the pay were made on the same medical procedures, on the same admission dates, but with different discharge dates.

At least Sh51,111,215 for four schemes incurred on payment of 2,808 claims, interestingly, for the same patient admitted in different hospitals at the same time.

There were also duplicate payments to the Linda Mama Programme which offers free deliveries to avert maternal and child deaths.

A sum of Sh5,713,000 was paid to NHIF for Caesarian Section (C-Section) deliveries.

“The statement of profit or loss and other comprehensive income and Note 16 to the financial statements reflect Linda Mama Programme expenses amount of Sh4,134,909,678,” reads a section of the audit report.

“The amount includes an amount of Sh5,713,000 paid to NHIF accredited hospitals whose analysis revealed 656 duplicate case code (01) on C-Section deliveries procedures carried out on the same patient,” the report adds.

Further analysis shows payment of Sh41,332,700 on 10,860 duplicate cases on normal deliveries for the same patients.

“In the circumstances, the accuracy and completeness of the Linda Mama expenditure of Sh47,045,700 could not be confirmed,” notes the report.

The Nancy Gathungu led report has also raised an issue with unexplained overpayment on National Health Scheme Expenses.

For example, the statement of profit or loss and other comprehensive income reflects National Health Scheme expenses balance of Sh34,362,413,090, whose expenditure included payments of Sh963,737,709 while their specified limits were Sh501,561,060.

The report poked holes in unexplained overpayments of Sh462,176,649 by the scheme.

Among the benefits that reported overpayment of tax payers’ money include normal deliveries, C-sections, rehabilitation, minor surgeries, major surgeries, specialised surgeries and basic chemotherapies.

Other benefits are complex chemotherapy, Magnetic Resonance Imaging services, (MRI) and Computed Tomography (CT) Scans.

“Analysis of the expenses revealed an unexplained overpayment balance of Sh1,750,250 above the specified limit,” reads the audit.

The Ministry of Health has been talking big on Universal Health Coverage (UHC), which it seeks to realise through the new health insurance scheme, Social Health Authority, whose registration process kicked off on July 1.

The audit report notes that the indigents' sponsorship programme cost Sh3,329,282,962.

Payment to the programme is reported to have been done prior to its launch. The programme, according to the audit, commenced in January 2022, while the launch of UHC was done on February 7, 2022.

However, examination of claim data revealed claims amounting to Sh11,924,766 for the years 2017 to 2021 which were presented before the programme commenced,” states the Auditor General.

A sum of Sh3,263,425 was also paid out of the scheme to members who are enrolled by NHIF in formal and informal categories and whose contributions were updated and active, and therefore they could not be categorised as poor and vulnerable.

“In the circumstances, the accuracy and completeness of the Indigents’ Sponsorship (GOK) Programme amount of Sh329,282,962 could not be confirmed”, reveals the report.

The financial statement by the auditor further scrutinises the indigents programme premiums  of Sh6,000,000,000.

It is noted that the contract was based on one million principal members at the rate of Sh6,000.

However, the programme had only 878,104 members.