According to Cabinet Secretary for Devolution Eugene Wamalwa, only 30 percent of the National Hospital Insurance Fund (NHIF) health scheme members have upgraded their registration status from Smartcard to biometric.
This is coming at a time the auditor general had flagged NHIF claims after an audit on its contracted hospitals revealed that some facilities have been relying on non-existent bed capacity to swindle it money through fictitious claims that contribute to loss of up to Sh16.5 billion annually.
NHIF said many hospitals had lied that they have theatres for operating patients while others had exaggerated their bed numbers by up to five times to defraud it. Such hospitals have then relied on the non-existent capacity to manufacture patient numbers and collect higher claims, driving up the amount of money spent on claims by between 10 percent and 30 percent.
“We had noted some unscrupulous activities where a hospital is captured that it has operating theatres or 100 beds when actually on the ground there is no theatre ad even beds are less than 20 beds. We now have a team of assessors who are going around to ensure there is a tally between what the hospital claims to have and the real capacity,” said Peter Kamunyo, the chief executive of NHIF.
NHIF Chief Executive Peter Kamunyo, in mid-June, had directed NHIF beneficiaries to enroll for a biometric registration exercise aimed at speeding services delivered by the fund.
It turns out that since the drive was launched, only 300,000 people have gone to get the registration representing 30 percent of all NHIF beneficiaries.
Kenyans have shunned a mandatory directive by National Hospital Insurance Fund (NHIF) in droves.
Speaking during a tour in Bungoma County, Devolution Cabinet Secretary for Eugene Wamalwa urged the 47 counties to mobilize their residents to enroll in the service. He also noted that the exercise had set back the state Ksh6 billion taxpayers money.
The directive was unveiled as part of the new changes under the mandatory Ksh500 premiums for all households proposed by the institution. The mandate was made by a special task force that had been constituted Health CS Mutahi Kagwe aimed at helping the fund Strategise.
Part of the resolutions from the task force includes the introduction of a biometric and electronic claims system and with more services expected to be added under the cover.
He further explained that the mandatory Ksh500 premiums for all households would help expand services available under the cover. Out of the 10.4 million Kenyans registered on the platform, only 5 million are active contributors and most of them are either formally salaried hence a requirement or are suffering from chronic illnesses.
Currently, NHIF members can only access services using a smart card it issues.
The NHIF collected Sh59.5 billion from the 8.9 million members in the year ended June 2020 and paid out Sh54.9 billion or 92.2 percent as claims to hospitals.
Dr Kamunyo says NHIF has sued several hospitals in the last one month and says it will increase surveillance and rely on the newly installed e-claims process to cut exposure to fraud.
