CS Nakhumicha Announces Suspension Of 27 Hospitals Linked To Ksh171M Fraud

Health Cabinet Secretary (CS) Susan Nakhumicha has announced the suspension of 27 hospitals found to be engaged in fraudulent activities resulting in the loss of Ksh171 million.

In a statement on Friday, January 5 accessed by Viral Tea, Nakhumicha revealed that the decision followed an audit carried out on 67 hospitals, out of which the 27 were discovered to be involved in the multi-million fraudulent activities targeting the National Hospital Insurance Fund (NHIF).

"Between January and December 2023, out of 67 audited hospitals, 27 were found to be involved in fraudulent activities, resulting in a loss of Ksh171 million.

"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 Ksh20 billion in losses from about 40% fraudulent hospitals. Luckily 60% carry out clean business," she stated in part.

The identified facilities, she announced, have been suspended, and recovery of fraudulent claims is proceeding.

The CS further noted that the list of implicated facilities included instances of induced demand, particularly targeting vulnerable citizens, notably older individuals, residing in regions such as Nairobi, Meru, Nyahururu and Murang'a.

Other regions include Kerugoya, Makueni, Tharaka Nithi, Subukia, Nanyuki, Bungoma, Chuka, and Machakos, with patients enticed into unnecessary medical procedures, exploiting their vulnerabilities.

Moreover, she revealed that instances of induced sickness had been uncovered, wherein facilities deceitfully activated dormant accounts of members, financing medically unwarranted treatments.

"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. Disturbingly, some hospitals have targeted groups of security guards from licensed security firms, financially inducing them to provide biometrics for fraudulent purposes.

"Anomalies have also been identified, including facilities conducting an exceptionally high number of eye surgeries in a day, ranging from 10 to 22, in facilities with a capacity of only 2 per day while lacking adequate theatre capacity. Such discrepancies raise significant doubts about the legitimacy of claims and the resources available at these facilities," she added.

Under the EduAfya cover, healthcare facilities were revealed to entice healthy students, providing food incentives for their biometrics, resulting in high financial losses.

Additionally, cases involving nurses stationed in schools collecting biometrics of non-ill students to lodge fictitious claims have been unearthed, significantly exploiting the scheme.

The hospitals include; Jekim Hospital -Nkubu Ltd, Jekim Medical Centre, Joy Nursing & Maternity, Amal Hospital Ltd, Beirut Pharmacy and Medical Centre, St. Peter’s Orthopedic and Surgical Specialty, Afya Bora Hospital Annex Ltd in Mwea, Charity Medical Centre, Queens and Kings Hospital, Chest & Skin Clinic and Kiritiri Medical Healthcare.

Others are Meswo (Tunza) Medical Services, Familia Bora Medical, Naivasha Quality Healthcare, Bingwa Family Clinic, Elburgon Nursing Home, Nyamira Jamii Medical, St. Joseph Shelter of Hope, Lenmek Hospital, Equity Afia Buruburu, Murang'a High School Dispensary, Mathingira Medical Centre, Ruai Medical Centre and Thuti Medical Clinic.

The CS assured that the newly-established Social Health Authority (SHA) is envisioned to reduce and eliminate fraud by automating services to minimize human interface, adding that the ICT systems are intended to have strong business intelligence modules to flag outliers and double payments in time.

"As we collectively tackle this crisis, we reaffirm our commitment to fortifying and safeguarding the integrity of our healthcare system.

"The government, in collaboration with relevant stakeholders, is resolute in ensuring that those responsible for these reprehensible actions are brought to justice, and our healthcare system is purged of this blight," she added.