Rédaction Africa Links 24 with Daily Nation
Published on 2024-01-30 12:01:56
The proprietor of a 21-bed-capacity hospital in Nairobi revealed to Members of Parliament (MPs) that he had pocketed Sh400 million from the National Hospital Insurance Fund (NHIF) while the insurer still owed him Sh78 million. Mr. Kennedy Otieno, the owner of Joy Nursing Home in Eastleigh, made the admission when the National Assembly’s Health Committee visited the facility on Monday. The committee was on a fact-finding mission and had raised questions about the hospital’s facility and business operations. Mr. Otieno disclosed that NHIF payments totaling Sh400 million were received between 2021 and 2023.
During the investigation, questions were raised about the hospital’s certification as a Level Four facility despite only having 21 beds, while the standard requirement is 30 beds each for males and females. The facility also lacked essential equipment, such as electricity, a blood transfusion unit, life support equipment, and a mortuary. Despite the limited capacity and resources, the hospital claimed to handle approximately 20 patients a day and had performed hundreds of surgeries, raising concerns about the discrepancy between the services provided and the facility’s capabilities.
Further scrutiny revealed issues with NHIF claims, with Mr. Otieno admitting that radiology films had been manipulated for pre-authorization to justify procedures that were never done. The hospital was among those suspended for five years after internal investigations by NHIF uncovered fraudulent activities involving several health facilities. Mr. Otieno indicated that quality assurance officers from NHIF’s Eastleigh branch had visited the hospital and granted accreditation for procedures requiring pre-approval.
The health committee emphasized the need to investigate the collusion between hospitals, NHIF authorities, and the Kenya Medical Practitioners Pharmacists Dentists Union (KMPDU). The NHIF had previously reported instances of fraud and corruption within its system, estimating a fraud risk of 29.3 percent. The committee also raised concerns about the pricing of drugs and services by some hospitals when claiming reimbursements from NHIF.
The MPs were further shocked to learn that NHIF’s Head of Provider Management had a different professional background and had him sacked. The health committee continued its investigation at other hospitals accused of NHIF fraud and vowed to make a comprehensive report and recommendations based on its findings. The scandal had also led to the liquidation of NHIF’s short-term assets and reserves, indicating the severity of the issue.
