MPs on Tuesday turned up the heat on NHIF CEO Samson Kuhora over fraudulent claims and payments to health facilities.
MPs are probing the illegal payment linking him to the suspicious payments.
The lawmakers have opened a 90-day probe into the circumstances that led to the payment of fictitious claims. They questioned how Kuhora was elevated to the top job despite working in the claims department where the payments were approved.
Moyale MP Jaldesa Guyo alleged he acting CEO was working in the claims department before his elevation to the helm of the agency.
"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," Guyo said.
The lawmaker put Kuhora to task to explain how the anomaly that vacuumed up tax payers' millions was carried at the national health insurer.
"All that we are investigating lies with the CEO and he needs to come clean on the facilities that were charging 20 or more times the approved rate," he said.
Nyeri Town MP Dancun Maina inquired why the state agency conducted market research on the prices of drugs to guide the payouts after it emerged NHIF relied on Essential Medicine List (EML).
"We have not conducted market research because we rely on EML system which guides us," Kuhora told the committee.
Kuhoraa rejected claims of superintending the claims payments.
"Prior to my promotion, I worked in data analytics department and did no case management, which is the charge of claims payments approvals," he told the committee chaired by Endebes MP Robert Pukose.
The CEO was also hard-pressed to explain how 60 per cent of the payments to the hospitals involved in fraud were approved by one officer from the case management department.
He was also put to task on the existence of a cartel at the health insurer working with cartels outside the country to fleece the agency.
Last month, Health Cabinet Secretary Susan Nakhumicha suspended eight rogue health centres, including Amal Hospital Limited and Berut Pharmacy and Medical Centre, and ordered a thorough probe into the payment of these fraudulent claims.
Other suspended facilities includ Jekim Medical Centre in Meru, St Peter’s Orthopaedic and Surgical Hospital in Kiambu, Afya Bora Hospital in Kirinyaga, Joy Nursing and Maternity Hospital in Nairobi and Afya Bora Hospital Annex in Kirinyaga.
Kuhora clarified the suspended facilities will remain so, in accordance with the contract terms of engagement, which include a 90-day suspension to allow for a thorough investigation.
“If it is verified that fraud has indeed taken place, the board can approve a suspension for five years as per the terms of engagement, and the facility can appeal after two years of the suspension,” he said.
