In February this year, details emerged about 80 health facilities countrywide being investigated for involvement in possible National Hospital Insurance Fund (NHIF) claims fraud.
While seven facilities have been suspended from offering services by NHIF over fraudulent activities, a bigger scandal is brewing at the insurer over M-Pesa contributions.
On Tuesday, the National Assembly Public Investments Committee (PIC) was jolted when acting NHIF CEO Nicodemus Odongo claimed that details of Kenyans contributing for the NHIF cover through M-Pesa could not reflect in the insurer’s system.
NHIF M-Pesa fraud
Odongo claimed that contributions made through M-Pesa have not been reflecting on the NHIF system since the affected contributors had used wrong details.
This means that thousands of Kenyans risk being locked out by the insurer when they need medical attention.
Effectively, the contributors are not covered by NHIF and cannot access health services through the NHIF cards.
At a time when technology is embedded in every aspect of life, Odongo claimed that he did not know the number of Kenyans affected by the glitch.
Saying that he would be able to provide the information on the exact numbers in two days, Odongo added, “I don’t know the number of people affected, because members pay different amounts while others choose to pay their contribution for the whole year.”
The national insurer collects amounts ranging from Ksh2.8 billion to Ksh3.2 billion in member contributions.
According to the Daily Nation, the insurer collected Ksh35 million in the year to June 2018 meaning.
The paper estimates that 70,000 people are affected by the M-Pesa transactions problem. If these members have been contributing loyally so far, it means that the insurer cannot account for Ksh350,000,000 for the 10 months this year.
In February, NHIF said that healthcare fraud, waste and abuse directly contributes to the need for higher premiums for sustainability. It claimed that this reduces the amount of money available to improve quality of care for beneficiaries.
“Fraud leads to the shrinking of the available benefits package to members, thereby raising barriers to accessing quality health and ultimately increasing the cost of healthcare,” said Gilbert Osoro, Manager, Benefits and Contracting at NHIF.
Confusion and audits
While Odongo claimed that contributors had used wrong details thus affecting their membership accounts status, he assured that the money is not lost.
In a confusing explanation to the committee, Odongo said that the money had not been reconciled to the contributors’ accounts.
The MPs questioned why NHIF had not surrendered the money to the Unclaimed Assets Authority (UFAA) saying there was a need for the Auditor-General to appraise the NHIF account.
The immediate former Auditor General Edward Ouko had spotlighted gaps in NHIF accounts in his 2017/2018 audit report. PIC is meeting the NHIF team today to conclude matter regarding the audit queries and members contributions.
In May this year, patients using NHIF cards at Kenyatta National Hospital (KNH) were stranded for days after system outage at the insurer.
The NHIF system at the hospital was inaccessible but Odongo, refuted this saying the system was up and running.
“NHIF system is alive and working very well everywhere, including at KNH,” said Odongo adding that NHIF has its own system which could have been the problem.
Am a victim ,I gave up on Nhif they don’t help even by visiting them I used to visit the office every month juu nimelipa na inaonyesha not covered
This is very unprofessional coming from an institution mandated to make sure Kenyans get health services.
Did they finally sort your issue?
Please rectify the situation. We are losing lot of cash. The playbill no. is it genuine?Do the needful help poor Kenyans from the health issues.
Hello, Agan!
This is for NHIF to do. The best is to visit their offices with your complaints and they should address the anomalies.
You can also email [email protected], [email protected] or [email protected]. They should assist you.
This NHIF thing is a fraud to con kenyans and a useless ,run by cartels! I also paid via mpesa and never got a response shame on or those who r involved in this scum
Indeed!
NHIF should ensure that these complaints are addressed.
I paid for my mum last saturday but on checking card staus its reflecting a different name. In fact showing the card belongs to a man but mums ID no.jane
The best is to keep checking and asking for your statement so that you keep up to speed with this.
Email [email protected], [email protected] or [email protected]. They should assist you.
Hi, no need to refer the amounts to unclaimed financial assets… they can see the number that paid, call them, ask for their Nhif & or ID number and this would reconcile the amounts…. 70,000 is not too much, hire accountants and let them reconcile…. then, do civic education and revamp the payment app to refuse erroneous entries. E.g. only recognizing ID numbers or a ‘hakikisha’ type of thing like what mpesa does when we send money
Exactly!
But it is a loophole that has been exploited. For it to come out now, the question is for how long has it been happening?
Is the information I get on sms no. 21101 regarding my balance wrong? This is normally up to date. Which payment mode is applicable?
Hello, Mbella.
Please talk to the NHIF guys on email: [email protected], [email protected] or [email protected].
They should assist you.
So what’s the correct Pay Bill Number?