Hospital founder fights off fraudulent NHIF payment claims

One of the hospital founders says his facility can do upto 30 surgeries per day

In Summary
  • In June, Health Cabinet Secretary Susan Nakhumicha suspended eight health centres.
  • MPs are probing the illegal payments to eight hospitals in suspicious payments.
NHIF headquarters in Nairobi.
NHIF headquarters in Nairobi.
Image: FILE

St Peter’s Orthopaedic and Surgical Hospital along Waiyaki Way has fought off allegations that it has been receiving fraudulent payments from the National Health Insurance Fund (NHIF).

Appearing before the National Assembly's Departmental Committee on Health, the founder of the Level Five hospital Gerald Wassena said his facility can do upto 30 surgeries per day.

"There is a huge need for specialised orthopaedic and surgical services, which are not commonly available in many facilities," he told the committee.

He told MPs St Peter’s Orthopaedic and Surgical Hospital is a 180-bed facility with "well-equipped and modern facilities."

Wassena noted that the facility has 34 consultant surgeons and eight ICU beds.

"Last year, we carried out over 8,000 surgeries and lost 24 patients. Medicine is about data, looking at the numbers, it is a good success," he stated.

He further said his hospital being along a busy highway, gets a lot of road accident victims.

MPs are probing the illegal payments to eight hospitals in suspicious payments.

In June, Health Cabinet Secretary Susan Nakhumicha suspended eight 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 include 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.

Committee chairman Robert Pukose noted that St Peter’s Orthopaedic and Surgical Hospital is being accused of wooing patients from Meru and Machakos counties.

"You have also been accused of holding medical camps," he said.

Wassena refuted the claim saying all his medical camps had permits.

"I, however, want to note that I have carried a patient in my own car. If that is ferrying patients, I am guilty as charged," he said.

In August, an audit by NHIF on its contracted hospitals revealed that some facilities have been relying on non-existent bed capacity to swindle money through fictitious claims that contribute to loss of up to Sh16.5 billion annually.

The state-controlled insurer says many hospitals had lied that they have theatres for operating patients while others had exaggerated their bed numbers by up to five times to defraud it.

Such hospitals have then relied on the non-existent capacity to manufacture patient numbers and collect higher claims, driving up the amount of money spent on claims by between 10 per cent and 30 per cent.

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