Auditor-General Nancy Gathungu has unearthed massive corruption at the National Health Insurance Fund (NHIF), revealing that the authority could not account for an additional Ksh368 million paid out to hospitals countrywide.
Gathungu revealed that NHIF paid out Ksh814.9 million to hospitals against total claims of Ksh447.12 million.
NHIF stated that the money was lost due to “typing errors” by hospital clerks. The auditor-general further revealed that the agency had failed to explain whether the money was retraced.
“Review of payment data revealed that the hospitals billed Ksh447,122,141 against claims paid amounting to Ksh814,893,467 resulting to unexplained variance of Ksh367,771,326. Although management attributed the variance to typing errors made by hospital clerks while inputting bill amounts in the e-claim system, there was no evidence of reconciling the billed amount to claims paid or requests for refunds for overpayments,” Ms Gathungu said in her report.
Under the year in review, Hospitals across the country made total claims of Ksh37.1 million through the Linda Mama Scheme but NHIF paid out Ksh91.6 million, an excess of Ksh54.5 million.
Gathungu noted that claims filed through the scheme were riddled with massive corruption, revealing cases of duplication.
“The amount includes Ksh5,713,000 paid to NHIF accredited hospitals whose analysis revealed 656 duplicate case code (01) on caesarean section delivery procedures carried out on the same patient. Similarly, the amount includes a balance of Ksh41,332,700 whose analysis revealed 10,860 duplicated case code (02) on normal deliveries on the same patient,” the audit notes.
Ms Gathungu further exposed instances of duplications and excess payments under the National Health Scheme (NHS). In one instance while hospitals billed the Fund Ksh280.6 million through the NHS Scheme, the NHIF paid Ksh486.6 million. The fund could not explain an excess of Ksh205.9 million.
“Analysis of claims payment schedules revealed an amount of Sh247,021,907 on duplicate payment of claims in respect to NHS at Sh221,448,407 and Indigent’ Sponsorship (GOK) Program at Sh25,573,500,” the audit notes.
