Health Cabinet Secretary Susan Nakhumincha has suspended 27 after an audit revealed the loss of Ksh.171 million through the National Health Insurance Fund (NHIF) program.
The audit, which took place between January and December 2023, found that approximately 40 per cent of the country’s hospitals, totaling 3,440 facilities, were involved in irregular processes resulting in losses of around Ksh.20 billion.
“Extrapolating this to the total population of 8,886 hospitals,it is estimated that approximately 3440 might have been engaged in fraudulent activities , potentially exceeding sh 20 Billion in losse from about 40 per cent fraudulent hospitals.Luckily 60 per cent carry out clean businesss,”stated the CS.
CS Nakhumicha expressed concern about the widespread nature of the alleged fraudulent activities, which included manufactured claims and fake surgeries.
“The widespread nature of these alleged fraudulent cases is deeply concerning.The list of implicated facilities includes instances of induced demand, particularly targeting vulnerable citizens ,notably older individuals,”she added.
Vulnerable citizens, particularly older individuals, were targeted in instances of induced demand.
Anomalies were also identified, such as facilities conducting an exceptionally high number of eye surgeries in a day, far exceeding their capacity.
“Anomalies have also been identified, including facilities conducting an exceptionally high number of eye surgeries in a day, ranging from 10 to 22,in facilities with capacity of only 2 per day while lacking the adequate theatre capacity. Such discrepancies raise significant doubts about the legitimacy of claims and the resources available at these facilities,” CS said.
The Ministry of Health has assured the public that steps are being taken to restore integrity in the provision of healthcare.
Efforts are underway to recover the lost funds, with Ksh.17.7 million already recovered out of the Ksh.171 million lost.
The suspension of the 27 hospitals is part of the government’s commitment to combating fraud and ensuring transparency in the healthcare system.
The audit findings suggest that a significant number of hospitals may have been engaged in fraudulent activities, potentially exceeding the estimated losses of Ksh.20 billion.
“It is estimated that approximately 3,440 hospitals might have been engaged in fraudulent activities (in 2023), potentially exceeding Ksh. 20 billion in losses from about 40 per cent fraudulent hospitals,”
Nakhumicha stated.
However, it is worth noting that 60 per cent of hospitals were found to have conducted clean business, indicating that the majority of healthcare facilities operate with integrity.
The Ministry of Health is expected to implement measures to prevent future fraudulent activities and protect the interests of patients and the NHIF program.
As investigations continue and more hospitals potentially face suspension, the government remains committed to ensuring that healthcare services are provided ethically and efficiently.
In the meantime, citizens are encouraged to report any suspicious activities or irregularities in healthcare facilities to the relevant authorities. The fight against healthcare fraud requires collective vigilance and a commitment to upholding the highest standards of integrity in the provision of healthcare services.
