August 2017 Businessdaily; The National Hospital Insurance Fund (NHIF) has begun a crackdown on hospitals making fake claims.
NHIF chief executive Geoffrey Mwangi said on Monday that hospitals were taking advantage of the insurer’s quick settlement of claims to make money fraudulently.
“Many claims have been rejected. Some hospitals are stealing from us and that has to stop,” Mr Mwangi said.
“The hospitals have been informed why we have taken time to pay. It is because we have set another layer for scrutinising claims.”
The CEO said some hospitals were duplicating claims and charging for services not rendered.
“Why would you bill us for serious surgery if you only conducted a minor one? Some hospitals say they performed three dialysis sessions when they have done only two,” he said, adding that it was wrong for doctors to set up stand-alone clinics and offer substandard treatment.
He said NHIF could place patients to units offering quality services. “We will not have a problem paying for that,” he said.
Mr Mwangi gave an example of a private hospital that was demanding Sh8.5 million for dialysis sessions in July alone.
“It means the hospital had 472 dialysis sessions and attended to 237 patients. Can a stand-alone clinic get this number of patients in a month?” he asked.
Mr Mwangi said reports doing rounds that NHIF does not have money are baseless. The insurer, he said, raised Sh23.7 billion revenue in the six months to December and paid benefits of Sh17.1 billion.
It had a surplus of Sh2.2 billion after operation costs, he added.