The Ministry of Health last week made public an audit report that shows rogue hospitals stole up to Sh20 billion from the National Health Insurance Fund.
This egregious crime not only jeopardises the financial stability of the insurer but also risks the lives of patients.
It is high time the authorities took decisive action against the culprits.
The NHIF collects about Sh6,000 from each member every year, with a promise to pay for their medical expenses if they fall sick.
However, rogue managers in private hospitals have resorted to overbilling, unnecessary medical procedures and misrepresentation of patient diagnoses to extract higher reimbursements from NHIF.
Such actions not only inflate the overall cost of healthcare but also divert resources away from those who genuinely need medical attention. Many patients are languishing in hospitals because the insurer is unable to clear their bills or pay for procedures they desperately need.
Penalties for the thieving hospitals and their managers should be severe enough to act as a deterrent. There must be increased transparency in billing practices by contracted facilities.
Regular audits and investigations should be conducted to identify any discrepancies between the billed amounts and the actual services provided.
The NHIF must also ensure members who have paid their premiums on time access health services without resulting in out-of-pocket expenditure.
It must also find ways to fully cover the outpatient and inpatient expenses of its members in public facilities.
Quote of the Day: “We only have to look at ourselves to see how intelligent life might develop into something we wouldn’t want to meet.”
Stephen Hawking
The English physicist was born on January 8, 1942
