MPs to commence public inquiry into NHIF fraud

National Health Insurance Fund offices, Nairobi. [Boniface Okendo, Standard]

A parliamentary committee will tomorrow begin a public inquiry into alleged fraudulent payments by the National Health Insurance Fund (NHIF).

The 90-day public inquiry aims to determine the current financial status of NHIF and to evaluate the efficiency of service providers.

The decision was arrived at after the House team heard views from stakeholders on the alleged fraud at the national insurer.

The National Assembly Departmental Committee on Health will also investigate allegations of corruption, fraud, and other malpractices in the payment of claims to health facilities, as reported in the media.

MPs will assess the efficiency and effectiveness of NHIF quality assurance mechanisms and determine the efficiency and effectiveness of human resource management.

Starting Tuesday next week, evidence sessions will be conducted, and the committee will later submit a report with recommendations to the government.

"In compliance with Article 118 (1) (b) of the Constitution, the committee hereby invites the public to submit memoranda on the specific terms of reference of the inquiry as outlined and on any relevant issue they may wish to draw the attention of the committee," the Clerk of the National Assembly Samuel Njoroge said.

"The memoranda may be addressed to the Clerk of the National Assembly, P.O Box 41842-00100 hand-delivered to the office of the clerk of the National Assembly, main Parliament Buildings, Nairobi, or emailed to [email protected] to be received on or before Friday, July 21, 2023, at 5pm," said Mr Njoroge

Endebess MP Robert Pukose (pictured), who chairs the committee, said the public inquiry will seek to address the deep-rooted problems within the struggling national insurer. "As a committee of parliamentary, we will hold NHIF to account because it is one of the key institutions that this government intends to deliver on its universal health care," said Dr Pukose.

Recently, during a meeting with the NHIF management, the MP said they will also scrunise the procurement practices.

"We also want to look at NHIF procurement, what is it that NHIF are procuring? Are you procuring at the expense of the patients? What are those things that you are procuring and whether they are relevant to the institution to your mandate," he said.

The committee's priority is to also establish whether fraud and other malpractices were committed in the payment of claims to eight health facilities that have been suspended for 90 days.

The facilities include Afya Bora Hospital, Afya Bora Hospital Annex, Jekim Hospital Nkubu Ltd, Jekim Medical Center, Joy Nursing and Maternity Eastleigh, and St Peter's Orthopedics and Surgical Specialty Hospital.

Pukose outlined the committee's intent to examine the claims paid to these facilities between July 1, 2022, and June 9, 2023, and the previous financial years.

"Were, the claims fictitious and exaggerated in the period in question. How did the alleged fraud happen and were the alleged fraudulent claims paid," the MP said

The committee also seeks to identify the individuals or entities involved in making and paying the fraudulent claims and assess the extent of their involvement.

They will investigate whether NHIF staff colluded with the eight health facilities and if there have been other reported incidents of fraudulent claims made by other facilities.

The committee will also delve into NHIF's payments to private and public health facilities over the past two financial years with the aim to address the widespread accusations that 60 per cent of the fund's payments favor private health facilities, particularly those with alleged connections to NHIF's top management.

Moyale MP Jaldesa Guyo Waqo questioned NHIF's criteria for determining the order and amount of claims paid to service providers, especially in cases of delayed payment.

"We want NHIF to reveal the criteria they use to determine the order of payment for claims received and the amount to be paid to each service provider, especially in cases where payment has been delayed," said Waqo.

Samburu Woman Rep Pauline Lenguris also questioned NHIF's payment of significant amounts to private health facilities without conducting due diligence, raising concerns about the neglect of public health facilities and the payments made to unverified private facilities, which have exposed vulnerable Kenyans to unnecessary suffering.