Auditor General Nancy Gathungu has flagged an excess payment of Sh367 million in claims to contracted health facilities. According to the details, while hospitals billed Sh447 million, the fund disbursed Sh814 million, resulting in an unexplained extra payment of Sh367 million.
The management attributed these discrepancies to typing errors.
These excess payments occurred under various schemes, including 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.
The 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 expenditures 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 duplicate claims, showing the same healthcare providers with different outstanding amounts and hospital codes. Among these flagged amounts, Sh247 million were identified as duplicate payments for claims supposedly paid to the same patient.
Notably, NHIF management paid Sh51 million for one patient who was recorded as admitted to different hospitals simultaneously. The audit revealed that this amount covered 2,808 claims purportedly for the same patient.
Additionally, Gathungu’s review found that benefits paid out under the Linda Mama program, amounting to Sh47 million, couldn’t be confirmed. It was established that Sh41 million was paid for normal deliveries under one patient’s name, with 10,860 duplicate claims raised.
Another Sh5.7 million was paid for caesarean deliveries supposedly performed on the same patient across NHIF-accredited hospitals.
These findings cast a spotlight on accountability concerns surrounding the Social Health Insurance Fund, which President William Ruto’s team has proposed to replace NHIF. The rollout of the new fund has been extended to October, but registration is scheduled to begin on Monday, July 1.
