In the National Hospital Insurance Fund’s (NHIF) crackdown of fraudulent medical claims by health facilities, the fund has revealed that health centers in Mount Kenya region, Coast and some parts of Western Kenya are most notorious in fraud cases.
This is as NHIF has confirmed that 80 health facilities are under investigation for involvement in medical claims fraud while 7 health facilities have been suspended.
NHIF Claims and Benefits Manager, Judy Otele, said impersonification, upcoding and fake surgeries are the three leading ways health centers are perpetuating fraud.
“Fraud is taking place every second, therefore, we cannot guarantee safety in any way however the use of technology we are adapting with the new measure gives us hope to fight fraud that tainted our name. It is also the responsibility of Kenyans to issue their contacts in order to get a notification when one is linked to a case of fraud,” said Gilbert Osoro, NHIF Benefits and Contracting manager.
The social health insurer will invest in technology such as SMS with information of the facility, nature of treatment and amount charged of the patient to curb the rising fraud cases in over the 8200 health centers covered by NHIF.