The National Health Insurance Fund (NHIF) has admitted to paying out Ksh 368 million in excess claims due to “typing errors,” with no proof of where the money went.
Auditor-General Nancy Gathungu’s audit for the year ending June 2023 uncovers systemic leakages within the Fund, which manages billions of shillings for Kenyans.
“The hospitals billed Ksh 447,122,141 against claims paid amounting to Ksh 814,893,467 resulting in an unexplained variance of Ksh 367,771,326,” Gathungu reported.
Despite blaming the overpayments on clerical errors, NHIF could not provide evidence of recovering the excess payments or reconciling the data with the hospitals involved.
The audit reveals glaring discrepancies within the Linda Mama scheme, which supports free childbirth services. Hospitals billed NHIF Ksh 37.1 million, yet the Fund paid out Ksh 91.6 million — an excess of Ksh 54.5 million.
Fraudulent activities included 656 duplicate case codes for caesarean sections and 10,860 duplicate case codes for normal deliveries on the same patients, amounting to Ksh 5.7 million and Ksh 41.3 million respectively.
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“These issues paint a grim picture of NHIF’s financial stewardship and raise serious questions about the Fund’s ability to serve its intended purpose,” Gathungu’s report concludes.
Hospitals have also been found raising claims five years past the 30-day submission deadline, further compounding the chaos.
Under the National Health Scheme (NHS), similar issues arose. While hospitals billed NHIF Ksh 280.6 million, the Fund disbursed Ksh 486.6 million, resulting in Ksh 205.9 million in unexplained excess payments.
Furthermore, a Ksh 12 billion debt owed to healthcare providers contained Ksh 2.9 billion in duplicated entries for providers with the same name but different amounts and codes.
The Auditor General’s report shows that these overpayments and duplications are just the tip of the iceberg.
The mismanagement exposes NHIF to losses amounting to billions of shillings, further exacerbating the suffering of patients who continue to experience poor services and, in some cases, denial of services altogether.
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