•The government in June last year embarked on a nationwide verification of medical claims lodged by health facilities under the NHIF
•This is in an effort to weed out rogue providers who are in the business of defrauding the fund via fake medical claims
Image: FILE
All pending medical claims owed by the National Health Insurance will be passed over to the Social Health Authority.
Health CS Susan Nakhumicha has said the repealed NHIF owes hospitals close to Sh29 billion in medical claims.
She has, however, emphasised that only genuine claims that will have been verified and reconciled will be paid to the facilities.
The now-repealed NHIF has been undertaking verification of claims after reports that some rogue health facilities were fleecing the national insurer with fraudulent claims.
“It is about Sh29 billion that NHIF owes hospitals. We are doing a verification exercise and reconciliation of those figures, we have been out there saying some of the facilities are fraudulent, some claims have to be verified then reconciled after that then payments come through,” Nakhumicha said.
“Payment of claims is a continuous exercise; that whatever gets verified gets paid so they will just cross over into SHA what has not been paid and verified,” she said.
The government in June last year embarked on a nationwide verification of medical claims lodged by health facilities under the NHIF.
This is in an effort to weed out rogue providers who are in the business of defrauding the fund via fake medical claims.
The verification process seeks to ensure any inconsistencies that may point to abuse of resources and theft across the country are flagged.
Nakhumicha has further noted that only health facilities that meet the laid down criteria will be empanelled under the new SHIF.
"We have to check against certain criteria to empanel facilities; we have rogue facilities outside here and those we shall not empanel, we will only empanel those that meet the criteria that have been prescribed," the CS noted.
She added: "The beauty about SHA is that they are going to be gazetted so the public will know the facilities that have been empanelled."
The CS said the process of clearing claims will be undertaken with a high level of accountability involving thorough verification before settlement.