Auditor General Nancy Gathungu has flagged an excess payment of Sh367 million in claims to contracted health facilities.
Details reveal that while hospitals billed Sh447 million, the fund paid out Sh814 million, leading to an unexplained extra payment of Sh367 million. Management attributed this discrepancy to typing errors.
The excess payments were made under the National Police Service, NHC, UHC, civil servants, Edu Afya, county, parastatal, and Linda Mama schemes.
“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,” Gathungu said.
This amount is just a fraction of what the auditor general flagged in a new report indicating that Kenyans could have lost billions.
The report states that NHIF management failed to explain the expenditure of more than Sh7.4 billion for the year ending June 30, 2023.
An analysis of bills owed to healthcare providers revealed Sh2.9 billion in respect of duplicate healthcare providers, with the same name but different outstanding amounts and different hospital codes.
Among the flagged amounts, duplicate payments totaling Sh247 million were claims passed off as paid to “the same patient.”
It was found that NHIF management paid Sh51 million for one patient who was admitted to different hospitals at the same time.
A review by the auditor revealed that this amount was for 2,808 claims purportedly for the same patient.
Gathungu also concluded that the benefits paid out under the Linda Mama program, amounting to Sh47 million, couldn’t be confirmed.
It was discovered that Sh41 million was paid out for normal deliveries for one patient under whom 10,860 duplicate claims were raised.
Another Sh5.7 million paid to NHIF-accredited hospitals turned out to be for caesarean deliveries performed on the same patient.
These ‘mistakenly’ paid out claims will no doubt irk more Kenyans, especially as the wastage comes at a time when President Ruto has doubled the payments deducted from Kenyans for NHIF. It will also raise questions about the prudence of the system, particularly with the new Social Health Insurance Fund, another pet project of Ruto, being rolled out in August.
