A parliamentary committee has now roped in the Kenya Medical Practitioners and Dentist Council in its probe into the fake NHIF claims by some private health facilities.
The development comes after the health committee established that some of the facilities flagged for fake claims were licensed by the regulator despite not meeting basic conditions.
Consequently, the panel is investigating a possible ring involving KMPDC, National Hospital Insurance Fund and the private facilities fleecing Kenyans of millions of shillings in fake claims.
“We are casting the net wider and we are going for all those agencies that aided the operations of these facilities despite not meeting basic requirements,” Ndhiwa MP Martin Owino said.
The MP who served as the temporary committee chairperson during the panel’s visit to various facilities in Nairobi accused of defrauding taxpayers, said they will also be going after KMPDC.
The council is the regulator that accredits health facilities.
In the visits, the committee established that some facilities have been licensed by the regulator to operate as Level 4 hospitals, but lack basic equipment and facilities needed for accreditation.
In Eastleigh, Nairobi, the MPs visited three facilities; Joy Nursing and Maternity Home, Amal hospital and Beirut hospital.
However, the panel only accessed Joy Nursing Home as the other two were locked. The three facilities have been flagged for allegedly fleecing NHIF millions of shillings in fake claims.
The committee also visited Equity Afia facility in Buruburu.
At Joy Nursing Home, the committee established that the facility is in a dingy place and lacked basic equipment to be licensed a Level 4.
For instance, the hospital, which has since been closed by KMPDC after revelations of fraud emerged, has 21 beds against 24 required for a Level 4 facility.
At the time of its establishment in 2006, the facility only had 14 beds but was still accredited as a Level 4 hospital.
The facility also lacks a blood transfusion unit, an autopsy room and a temporary morgue required for a Level 4.
“You don’t have all these, how did you get a license to operate?” Owino asked the facility’s proprietor Kennedy Otieno.
“We did not accredit ourselves. We applied to the council and their people came and assessed our facility,” Otieno said.
He said NHIF officials also assessed the facility and certified as qualified.
Citing an audit report by NHIF, the MPs said the facility has made claims worth in excess of Sh400 million in the last four years.
From July 2022 to May 2023, the facility filed 6,707 claims valued at Sh368 million.
However, most of the claims are said to be fake with the facility accused of falsifying data to inflate the claims.
But Otieno denied the claims.
“That is not possible. We captured every patient’s details from here before we sent to NHIF,” he said.
The committee is also investing the connection between Joy hospital and specific facilities in Meru, Machakos and Narok that have specifically been referring their patients to the facility.
“This is a ring involving rogue KMPDC and NHIF officials and these facilities, we must get to the bottom of it,” Kitutu Chahce South Antony Kibagendi said.
At Beirut, the facility was completely closed with no signs of recent activities.
However, at Amal hospital, the committee established that the facility was closed on the day of the visit by the management who had been informed of the MPs' visit.
“We are going to summon the owner of this facility to come before us because we cannot allow rogue facilities to continue fleecing Kenyans,” Owino said.
At Equity Afia in Buruburu, the committee questioned the management about the abnormal claims filed by the facility in relation Edu Afya scheme.
The facility provided medical services to students in at least nine schools within its vicinity. They claimed millions of shilling.’
However, NHIF established alleged fraud and demanded refund from the facility.
On Tuesday, the committee visited St Peter's Orthopedic hospital in Kangemi which has also been accused of involvement in alleged fake claims.
