There have been a lot of complaints that hospitals are colluding with National Insurance Fund to generate false medical bills for people who have not sought treatment. The Directorate of Criminal Investigations (DCI) is looking into how NHIF officials pocketed up to Sh12 billion from beneficiaries who had not sought medical treatment from any hospital.
Investigations revealed rogue NHIF officials might have colluded with hospitals to generate the false claims.
Detectives had obtained a court order requiring the hospitals to produce books of accounts, invoices and claims for payment by NHIF from 2013 to date.
In the new hanges, National Hospital Insurance Fund will no longer accredit health facilities, under new reforms aimed at delivering Universal Health Coverage (UHC) by 2022.
The Health ministry and the Medical Practitioners and Dentists Board will be the accrediting agencies.
“NHIF will move away from issues that are peripheral to it. The Ministry of Health and the board will carry out the work,” Health Cabinet Secretary Sicily Kariuki said.
When they take over, the Health ministry and the medical board will monitor payments to hospitals, assess the quality of services Kenyans are getting and the competencies of the facilities.