Twenty-seven hospitals at the centre of the Sh171 million National Hospital Insurance Fund (NHIF) fraud have been suspended.
According to Health Cabinet Secretary Susan Nakhumicha, an investigation into the fraud revealed that a Sh20 billion had been lost.
“Between January and December 2023, out of 67 audited hospitals, 27 were found to be involved in fraudulent activities, resulting in a loss of Sh171 million,” she stated.
“Extrapolating this to the total population of 8,886 hospitals, it is estimated that approximately 3,440 might have been engaged in fraudulent activities, potentially exceeding Sh20 billion in losses from about 40% fraudulent hospitals. Luckily 60% carry out clean business.”
The hospitals include; Jekim Hospital in Nkubu, Meru County, Jekim Medical Centre, Joy Nursing and Maternity in Eastleigh, Nairobi, Amal Hospital, Beirut Pharmacy and Medical Centre and St. Peter’s Orthopedic and Surgical Specialty in Nairobi’s Kangemi area.
Others are; Afya Bora Hospital in Mwea, Charity Medical Centre, Queens and Kings Hospital, Chest and Skin Clinic, Kiritiri Medical Healthcare, Tunza Medical Services, Familia Bora Medical, Naivasha Quality Healthcare, Bingwa Family Clinic, Elburgon Nursing Home, Nyamira Jamii Medical, St. Joseph Shelter of Hope, Equity Afia in Buruburu, Lenmek Hospital, Muranga High School Dispensary, Mathingira Medical Centre, Ruai Medical Centre and Thuti Medical clinic.
“27 hospitals were found to be involved in fraudulent activities, resulting in a loss of Sh171m. Extrapolating this to the total population of 8,886 hospitals, it is estimated that approximately 3,440 might have been engaged in fraudulent activities, potentially exceeding Sh20 billion in losses from about 40pc fraudulent hospitals,” said Nakhumicha.
The Ministry added that recovery of fraudulent claims is in process.
Out of the sixty-seven (67) audited facilities, 60 per cent were found to be carrying out business transparently.
The CS noted that the facilities used various methods to conduct the fraud such as targeting vulnerable citizens residing in Nairobi, Meru, Nyahururu, Muranga, Kerugoya, Makueni, Tharaka Nithi, Subukia, Nanyuki, Bungoma, Chuka, and Machakos regions.
The facilities also enticed patients into unnecessary medical procedures, induced sickness and in some instances activated dormant health insurance accounts.
“Fictitious records, manufactured claims, and deceptive practices, such as falsely indicating members undergoing major surgeries while actively at work, have all contributed to defrauding the Fund,” she said.
Some hospitals were found to target security guards from licensed security firms, financially inducing them to provide biometrics for illegal purposes.
