The National Hospital Insurance Fund (NHIF) has suspended Amal and Beirut hospitals in Eastleigh after the two facilities were found guilty of alleged medical fraud in Nairobi and Meru counties.

A media expose revealed how eight medical facilities siphoned millions of shillings from the Fund through fraudulent claims.

While appearing before the National Assembly’s Health Committee chaired by Dr. Robert Pukose, NHIF acting CEO Samson Kuhora said six other hospitals are under investigation.

The six are Afya Bora Hospital, Afya Bora Hospital Annex, Jekim Hospital Nkubu Ltd, Jekim Medical Centre, Joy Nursing and Maternity Eastleigh, and St. Peter’s Orthopaedics and Surgical Specialty.

”Investigations have found that there was fraud in relation to members who used the service as reported in the media. Amal Hospital and Beirut Hospital, which are based in Eastleigh have been found guilty, and reports have been completed and submitted to the board.’’

”For the others, the investigations, which started on July  16, are still ongoing and are expected to be completed in 90 days,’’ said Kuhora.

NHIF to allow Kenyan men to cover multiple wives with Sh. 500

Health facilities found guilty of the fraud will face a five-year suspension and can appeal the decision after two years.

”What we are currently recovering is the amount listed as lost by the fund,’’ added Kuhora.

NHIF suffered a Ksh.6 billion loss in the last financial year, attributed to non-payment of premiums and fraudulent payments.

The revelation was made after the National Assembly Committee on Health launched an investigation into alleged fraudulent payments of medical claims and capitation payments to health facilities.

The committee noticed a huge jump in claims, especially in particular schemes sponsored by the government. One of the main concerns was the Edu Afya scheme, whose claims have surged to Ksh3.5 billion in the last financial year from Ksh.800 million 4 years ago.

NHIF announces new benefits to members in revamped Supa Cover scheme

While admitting to cases of fraud in the payment of claims, Kuhora said there had been several forensic audits to diagnose the root problem.

“Edu Afya is one of the schemes that has been giving us concerns, it has grown from 800 million 4 years ago to Ksh.3.5 billion. It’s one of the schemes we suspect fraud has been ongoing. we have done several audits because in this scheme, most members are between 13 and 19 years, and we don’t expect claims to be this high.’’

Members of the committee, however, held Kuhora responsible for the gaps as he was heading one of the main departments in payment of claims before his promotion to CEO in March this year.

“I feel like you might have been elevated to acting CEO to conceal what you have been doing… Unless you prove otherwise, in your position three months ago, what we are investigating is what you were doing before being elevated,” Moyale MP Jaldesa Guyo said.

Kuhora refuted the claims saying that NHIF had already taken action by suspending contracts with six hospitals for a period of 90 days.