NHIF Building. The Fund says it has in the past raised the alarm over rising cases of increased medical fraud from both private and public health institutions.

The National Hospital Insurance fund (NHIF) is reported to have spent Ksh1.76 billion towards the treatment for kidney failure in the financial year 2017/2018.

This marked a 30 percent increase from Ksh1.24 billion spent in the previous financial year 2016/2017.

In the last half of the 2018/2019 financial year, NHIF paid Ksh64.7 million to help with treatment for Kidney transplant, an increase from Ksh2.7 million spent in the previous year.

The top expenditure per health care benefit package utilization report released by the national health insurance provider shows that the the last half of 2018, Ksh922.8 million was paid for 73.757 kidney dialysis session.

Nairobi County was reported to be the highest beneficiary.

Kidney renal dialysis is covered per family, and is applicable to inpatient and outpatient care for pre-dialysis, intra dialysis and dialysis care under the renal Dialysis and Kidney Transplant Package.

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According to the report, for national scheme members under the package NHIF pays unto a maximum of Ksh500,000 for. Kidney transplant for both local and oversee transplant.

“The package covers pre-transplant, intra-transplant session and immediate post-transplant inpatient care. Overseas claims payments are made to the treating facility, subject to meeting overseas claim requirements,” read the report.

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The requirements for overseas treatment include referral by a certified nephrologist or urologist, evidence of an identified matching kidney donor, letter of no objection by the Director of Medical Services, Quotation of the cost of care by overseas care provider and evidence of scheduled transplant care plan.

“Other requirements include letter of exclusivity from the Local Overseas Care Manager, and evidence of ability by the member to meet extra treatment costs, including travel insurance and overseas stay,” added the report.

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