• Health Committee chaired by Endebess MP Robert Pukose has questioned significant amounts paid to private hospitals
• The lawmakers seek to engage a number of stakeholders and make recommendations to the government
Image: MAGDALINE SAYA
MPs have planned a public inquiry starting next Tuesday on the alleged fraudulent payments of medical claims and capitation payments to health facilities by the National Health Insurance Fund.
In the 90-day probe, the Health Committee of the National Assembly aims to determine NHIF’s financial status, evaluate the fund’s efficiency and effectiveness.
MPs will also assess the efficiency and effectiveness of NHIF quality assurance mechanisms as well as its human resource management.
The lawmakers seek to engage stakeholders and make recommendations to the government.
National Assembly Clerk Samuel Njoroge, in a public notice, invited public views and memoranda on matters touching on NHIF.
Health Committee chair and Endebess MP Robert Pukose said the public inquiry will not be a witch-hunt.
The MP said the committee would among others scrutinise NHIF's procurement practices.
“What is it that NHIF is procuring? Are you procuring at the expense of the patients?” he asked.
Among questions by the House team is why NHIF is paying significant amounts to private health facilities “without conducting proper due diligence”.
The private hospitals are said to be submitting claims surpassing the number of surgeries performed at Kenyatta National Hospital and Moi Teaching and Referral Hospital.
Nyeri Town MP Dancun Mathenge, a member of the Health committee, said they would also seek to understand NHIF's revenue streams.
“We want to understand the amounts NHIF receives per month from pay slip deductions, voluntary contributions and penalties charged for late payments. NHIF must provide transparency regarding its inflow and outflow of money,” he said.
Eight health facilities suspended by the fund over fraud allegations will be the centre of focus, too.
They are Afya Bora Hospital, Afya Bora Hospital Annex, Jekim Hospital Nkubu Ltd, Jekim Medical Center, Joy Nursing and Maternity Eastleigh, and St Peter's Orthopaedics and Surgical Specialty Hospital.
Pukose said the committee will examine claims for July 1, 2022 to June 9, 2023 against those of the previous financial years.
The committee also seeks to identify the individuals or entities behind the suspect transactions, and whether there was collusion on part of NHIF staff.
“The amount paid to the suspended hospitals, since it was fraudulently acquired, should have been recovered,” said Webuye East MP Martin Pepela.
The committee will also delve into NHIF's payments to private and public health facilities over the past two financial years.
"We want NHIF to reveal the criteria they use to determine the order of payment for claims received and the amount to be paid to each service provider,” Moyale MP Jaldesa Waqo said.
Mogotio MP Reuben Kiborek of the committee expressed concern about the entrenchment of a culture of impunity at NHIF.
“Why is NHIF paying millions to private health facilities at the expense of the public health facilities, where patients are suffering?” Samburu Woman Representative Pauline Lenguris asked.
The committee will also examine NHIF's structures and assess whether its systems can authenticate and verify claims made by the contracted service providers.
Lawmakers will also evaluate the measures implemented by the Ministry of Health and NHIF to curb fraud and other malpractices.
If necessary, the committee will recommend legislative and policy interventions, including the review of penalties related to medical insurance malpractices, to enhance deterrence.
The committee is also interested in understanding the feasibility of the various NHIF packages and the outstanding amounts owed to health facilities in terms of rebates and capitations.
They seek clarification on NHIF's reserve policy, if any, and the current amount in the fund's financial reserves.
The committee will propose solutions to ensure timely payments of capitations and claims to prevent cardholders from being denied services by empanelled service providers.