The Health Ministry has taken decisive action by suspending twenty-seven (27) hospitals nationwide for their alleged involvement in unethical practices resulting in defrauding the National Hospital Insurance Fund (NHIF).
Health Cabinet Secretary Susan Nakhumicha announced on Friday, January 5, that the Ministry had audited 67 hospitals, discovering 27 hospitals engaged in various unethical activities. These included enticing patients into unnecessary medical procedures, submitting false NHIF claims, conducting multiple eye surgeries without proper theatre equipment, and engaging in fictitious surgeries.
The total estimated losses from these activities amount to Sh171 million.
Among the hospitals implicated are Jekim Hospital in Nkubu, Meru County; Jekim Medical Centre; Joy Nursing and Maternity in Eastleigh, Nairobi; Amal Hospital; Beirut Pharmacy and Medical Centre; and St. Peter’s Orthopedic and Surgical Specialty in Nairobi’s Kangemi area. Other affected facilities include Afya Bora Hospital in Mwea, Charity Medical Centre, Queens and Kings Hospital, Chest and Skin Clinic, Kiritiri Medical Healthcare, Tunza Medical Services, Familia Bora Medical, Naivasha Quality Healthcare, Bingwa Family Clinic, Elburgon Nursing Home, Nyamira Jamii Medical, St. Joseph Shelter of Hope, Equity Afia in Buruburu, Lenmek Hospital, Muranga High School Dispensary, Mathingira Medical Centre, Ruai Medical Centre, and Thuti Medical Clinic.
According to Nakhumicha, "27 hospitals were found to be involved in fraudulent activities, resulting in a loss of Sh171m. 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 Sh20 billion in losses from about 40% fraudulent hospitals."
The Ministry has initiated the recovery process for these fraudulent claims.
Of the audited facilities, 60% were found to be operating transparently.
The CS highlighted that these hospitals employed various tactics to perpetrate fraud, targeting vulnerable citizens in regions such as Nairobi, Meru, Nyahururu, Muranga, Kerugoya, Makueni, Tharaka Nithi, Subukia, Nanyuki, Bungoma, Chuka, and Machakos. They engaged in practices like inducing unnecessary medical procedures, inducing sickness, and activating dormant health insurance accounts.
"Falsified records, manufactured claims, and deceptive practices, including falsely indicating members undergoing major surgeries while actively at work, have all contributed to defrauding the Fund," she emphasized.
Additionally, some hospitals targeted licensed security guards, enticing them financially to provide biometrics for illicit purposes.