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MEDICAL FRAUD

Kagwe blames rogue hospitals for draining NHIF

Claims by facilities jumped from Sh19.7 billion in 2015/2016 to Sh54.6 billion in 2020/2021

In Summary
  • He supported the decision by Senate to reduce the penalty for fraud from Sh1 million to Sh100,000 or a six-month jail term.
  • The CS said the review will also enable the NHIF to periodically increase its funding pool to match the rise in treatment costs. 
Health CS Mutahi Kagwe in a past photo.
Health CS Mutahi Kagwe in a past photo.
Image: MAGDALINE SAYA

Health CS Mutahi Kagwe has asked the National Health Insurance Fund to review its regulations to reduce medical fraud.

He said the fund has been grappling with a rise in claims paid and increase in impersonation cases.

Claims by contracted facilities jumped from Sh19.7 billion in financial year 2015/2016 to Sh54.6 billion in financial year 2020/2021, Kagwe said.

The NHIF Amendment Bill 2021, which MPs passed on December 21 and is now awaiting President Uhuru Kenyatta’s assent, allows the agency to review funds paid to contracted facilities once every two years.

“The biennial review will enable the fund to seal loopholes that some dishonest health service providers have been using to enrich themselves at the expense of Kenyans,” Kagwe said in a statement to newsrooms.

He supported the decision by Senate to reduce the penalty for fraud from Sh1 million to Sh100,000 or a six-month jail term.

He said this would encourage more Kenyans to report on fraudsters.

“While it is important to punish and deter fraudsters, it is equally important not to be seen as being too punitive as this reduces the willingness of the public to report fraudulent activities,” Kagwe said.

The CS said the review will also enable the NHIF to periodically increase its funding pool to match the rise in treatment costs. NHIF last reviewed its rates to the public in 2015.

NHIF will be the driver of the Universal Health Coverage, one of the Big 4 projects by President Kenyatta.

“UHC will make fundraisers to cater for hospital bills a thing of the past. At the moment, it is common to see even Kenyans deemed to be well-off organising a fundraiser whenever a family member falls sick,” Kagwe said.

The amended law also prevents NHIF from withdrawing the benefits of a person undergoing treatment for a chronic illness.

The Bill is also a sigh of relief for employers who have been exempted from mandatory topping up of contributions for their employees whose pay is less than Sh500.

An employer other than the national government or county governments or their entities liable to pay a matching contribution under section 15 may be exempted from paying such matching contribution.

.... if that employer has procured a private health insurance cover for its employees and the benefits are equal to or better than the benefits that the employees are entitled to under this Act," the amendments read.

It provides that an employer, other than the county and national government, can make an application to the NHIF board to be exempted from topping up the contributions for their employees.

Earlier, employers had petitioned Parliament to remove the proposal requiring them to match their workers’ NHIF contributions.

They argued that it would add burden to them as they struggle to recover from the ravages of the Covid-19 pandemic.

The lawmakers also amended the provision exempting national and county governments from penalties for failed or delayed disbursements to NHIF.

 

 

-Edited by SKanyara