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January 22, 2019

VIOLA KIPTAI: Kudos to NHIF for war on fraud

Medical fraud
Medical fraud

The arrest and prosecution of top state officials suspected of committing fraud must have sent shivers down every Kenyan’s spine. Corruption hurts every Kenyan and we should all join the fight against it.

We have heard of hospitals submitting fake claims to the NHIF and defrauding the fund. We have also heard of people who used fake identities to seek medical care. This is theft and corruption, and should be weeded out.

In 2009, medical fraud led to revenue losses estimated at 40 per cent of total claims at NHIF or Sh1.6 billion. In 2015, the insurance sector lost Sh324.7 million through fraudulent claims. According to the Insurance Fraud Investigation Unit, this was a 215 per cent rise from Sh102.7 million in 2014.

Health insurance ranked third as the class with the highest volume of fraud, followed by theft by insurance employees. This is worrying and that’s why we must all commend NHIF for rolling out the use of fingerprints to identify its more than six million members in the battle against fraudsters.

With the programme in place, President Uhuru Kenyatta can rest assured the Big Four agenda will be achieved. The plan can only be achieved if the nation is healthy and its people are working. The biometric registration of NHIF members will ensure that the goal to provide universal healthcare is also achieved.

At least 1,370 hospitals have been fitted with biometric kits. In future, the National Hospital Insurance Fund should provide all facilities with these kits. We should all be patient because the programme will take three years and will be completed by 2020.

Currently, the fund has about 6.7 million principal members and, in total, serves about 20 million Kenyans. Kenyans should embrace the biometric system, as it will ensure transparency and accountability

Biometrics is an automated method of identifying a person, based mostly on physiological characteristics. We should also laud NHIF for setting up a pre-authorisation that approves all expenses for surgical conditions and services such as MRI, CT scans, radiation and chemotherapy.

Recently NHIF took one facility in Ukambani to court. The facility carried out one surgery and billed NHIF for eight. Twenty-six other facilities are under investigation and it’s time DCI boss George Kinoti and Director of Public Prosecutions Noordin Haji weeded out such characters from the healthcare system.

These are the people killing innocent Kenyans and they should be jailed for life. It will therefore be good if medical fraud — medics billing for services not offered, duplicating claims, offering excessive or unnecessary services — is tamed.

Unnecessary service occurs when claims are filed for care that in no way applies to the condition of a patient, such as an echo-cardiogram billed for a patient with a sprained foot. Currently, members and their dependants are required to produce their NHIF and identification cards before receiving services.

In 2015, the NHIF started the biometric registration of civil servants and security officers as the first step to migrate its members to the use of smart cards to identify themselves in hospitals.

The fund should also be lauded for rolling out the out a health cover tailor-made for students in public secondary schools launched by President Uhuru Kenyatta in April. This came against the backdrop of efforts to enable the country achieve universal healthcare (UHC) by 2022.

NHIF branch offices are to carry out biometric registration of students in schools and issue cards. Form 4 students will be required to exit from the scheme upon completion of Kenya Certificate of Secondary Education (KCSE) examination.

NHIF has already held an inception meeting with close to 650 healthcare providers identified countrywide to lay down procedures and modalities of ensuring smooth delivery of services to the students. Numerous students are already benefitting from the cover, with close to 600 treated countrywide.

This shows s that technology can help curb fraud and we should all support NHIF in rooting out this vice.


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