NHIF gets six detectives to investigate fraudulent claims

The National Health Insurance Fund has invited detectives from the Directorate of Criminal Investigations to probe the loss of up to Sh500 million every month through fictitious claims.

NHIF chief executive Geoffrey Mwangi told the Nation that the fund is expecting six detectives from the DCI to commence the investigation into the loss Monday.

The detectives will analyse hundreds of claims with a view to identifying fictitious ones before cracking down on the fraudsters.

“We are expecting six officers from the Directorate of Criminal Investigations at our head office on Monday. The cases are on the rise and the sooner we act the better because we want the providers to conduct genuine business,” Mr Mwangi said.

FRAUDULENT CLAIMS

He said that the fund has been relying on two detectives to crack down on the fraudsters but had opted to bring on board more investigators because of the rising cases of fraudulent claims.

He blamed the increase in fictitious claims on collusion between a section of the Fund’s unscrupulous employees and some hospitals.

“It is very unfortunate that some health providers are colluding with some of our employees but the moment that happens, it is a criminal offense and that’s why we are bringing on board the officers,” Mr Mwangi said.

“We cannot undertake prosecution ourselves, we have to rely on other arms of government. We have several cases but we don’t know the extent to which the providers have gone. We will soon catch up with them,” he said.

VERIFY AUTHENTICITY

Some of the cases being investigated with a view to initiating prosecutions include impersonation, hospitals launching claims with the intention to defraud NHIF using members’ cards without their consent and claiming for services not performed.

He gave an example of a patient who impersonated a NHIF card holder to get maternity services at Kitengela Medical Centre yet she was not a beneficiary. The fraudster was later apprehended and taken to court.

“The card is meant for the holder and beneficiaries and the moment they use it on another person, it becomes a criminal offense,” he said.

Mr Mwangi said the Fund had withheld payments due to about 20 health facilities but added that the detectives would also investigate past payments to verify their authenticity.

He asked Kenyans and health providers not to misuse the cards.

Mr Mwangi had earlier warned the health providers that they would crackdown on hospitals making fake claims.

He said that hospitals were taking advantage of the insurer’s quick settlement of claims to make money fraudulently. “Many claims have been rejected. Some hospitals are stealing from us and that has to stop,” Mr Mwangi said.

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