MPs were yesterday told that the national health insurer paid Work Injury Benefits Act (WIBA) premiums totalling Sh9 billion yet the total claims made by patients stood at only Sh200 million.
At a meeting with the National Health Insurance Fund (NHIF) acting Chief Executive Samson Kuhora, MPs concluded that based on the figures, some people had hatched a plan to swindle Kenyans of at least Sh8.8 billion.
Led by National Assembly Health Committee chairperson Robert Pukose , the MPs said NHIF should reconsider paying such high premiums.
Said Pukose: “You cannot be paying Sh9 billion to insurance companies. This is clearly a cash cow for some individuals. It is against this that we will be coming up with a recommendation that we will take to the House for approval.”
He added: “We are aware that the fraud that is happening in NHIF is not about the system alone but also human interference. The blame is not only quality assurance people but also the claims people at the headquarters. Now that you want to protect them, this committee will make a decision about this matter that will not be very good to some of you.”
Mwea MP Mary Maingi wanted NHIF to explain whether they had put in place measures to reduce the premiums being paid as they were too high.
She said: “You paid premiums worth Sh9 billion yet the claims are only Sh200 million. Could you tell us whether someone is thinking outside the box about this or this is a cash cow for you people?”
Nyeri town MP Duncan Mathenge sought to know why the premiums for WIBA have been increasing on a yearly basis compared to other insurance schemes being offered by NHIF.
“When I look at your document, I can see that in the 2020/2021 financial year, there was an increase in claims from Sh833 million to Sh2 billion in the 2022/2023 financial year. Could you explain why there is a significant jump in this, what is causing this,” he said.
Kuhora admitted that there was low payout but sought for more time to get details on how the payouts were done.
He, however, told MPs that payouts to individuals went up during the Covid-19 period as the institutions had to support government officers who sought their intervention.
“The scope related to the management of Covid-19 is what pushed the premiums as we had to support the workers. We supported around 599,000 workers,” he said.
But MPs accused him of lying on oath as the national health insurer did not pay for Covid patients as this expense was catered for by the government.
Said Maingi: “Chairman the CEO is not telling us the truth. NHIF did not pay for Covid patients. This was catered for by the government.”
Added Pukose: “Mr CEO, you can’t lie on oath the way you are doing.”
The committee at the same time directed that the fund upgrade its biometric systems and not procure a new system as this would be costly.
NHIF was initially planning to spend Sh4.2 billion to install a new biometric system yet the current system cost Sh1.6 billion.
The committee’s decision came after acting ICT Director Washington Okoth said the gaps raised regarding the system can be solved through an upgrade.The official told the committee that there is no need to buy an extravagant system as the current biometric system is new and up to date with technological standards.“The system which was put in place in 2018 encompass Electronic with encrypted communication between providers and the fund. The technology has eliminated fraud impersonation and reduced paper work across its countrywide branches,” he said.
