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.