2024 is off to a challenging start for the National Health Insurance Fund (NHIF), as they recently suspended operations at 27 hospitals throughout the country. These hospitals were implicated in a $126+ million fraud that has taken money and diverted resources from the NHIF. What do citizens need to know about this scandal?
The NHIF uncovered fraud at 27 hospitals across the country. So far, the fraud appears to have occurred between January 2023 and December 2023. It was uncovered through audits that were performed at 67 different hospitals. While 27 hospitals have been caught so far, it is anticipated that more fraud may be uncovered as other hospitals are examined. So far, a loss of 20 billion Kenyan shillings ($126.7 million USD) has been found.
Based on the most recent reports, the hospitals involved in the NHIF fraud were falsifying records, lying on documents, manufacturing claims, and doing deceptive things to receive greater reimbursement. For example, claiming that legitimate patients were receiving major surgeries or procedures that never occurred. In other cases, the hospitals would reactivate dormant NHIF accounts that were once valid to attempt to receive reimbursements. These tactics are a major red flag and show that corruption and fraud are occurring in many hospitals throughout Kenya.
Currently, all of the implicated hospitals have been suspended. However, the discovery of this fraud is fairly new, so there have not been additional consequences. Many experts anticipate that the auditing programs from the NHIF will be expanded to detect more fraud. Because 40% of the hospitals audited last year were found to be committing fraud in some fashion, it is important that fraud detection is expanded to recover funds. The NHIF cannot help Kenyans if some hospitals are taking advantage of the program to commit fraud, and as more hospitals are caught, it should also help to discourage other hospitals from doing the same in the future.
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