Auditor General Nancy Gathungu has flagged excess payment of Sh367 million in claims to contracted health facilities.
Details show that while the hospitals billed Sh447 million, the fund paid out Sh814 million, leading to an unexplained extra payment of Sh367 million that management attributed 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.
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 says the NHIF management failed to explain expenditure of more than Sh7.4 billion, as per the report 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.
Of the amounts flagged, cases of duplicate payments to the tune of Sh247 million were claims passed off as paid to ‘the same patient’.
It has emerged that the 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 the amount was for 2,808 claims purported to be for the same patient.
Gathungu has also concluded that the benefits paid out under the Linda Mama programme to the tune of Sh47 million couldn’t be confirmed.
It was established that Sh41 million was paid out for normal deliveries for one patient under whom 10,860 claims [duplicate] were raised.
Another Sh5.7 million paid to NHIF-accredited hospitals turned out to be for caesarean deliveries carried out on the same patient.
The findings cast a spotlight on accountability concerns around the Social Health Insurance Fund that President William Ruto’s team has fronted to replace NHIF.
Rollout of the new fund has been extended to October but registration is scheduled to begin on Monday, July 1.
Responsibilities of the president of the Law Society of Kenya