Principal Secretary for Medical Services Harry Kimutai, has announced that NHIF employees will undergo a vetting exercise before being integrated into the Social Health Authority (SHA). This process aims to weed out corrupt individuals from the public sector.
Speaking during the handover of NHIF graft report on Tuesday, March 5 by Ethics and Anti-Corruption Commission (EACC) to SHA, the PS noted that only staff who will pass the vetting process will be transitioned to the new authority.
“We want to make sure operations of social health authority that we are going to put in place are going to support and to ensure that there’s no more fraud in the claims a challenge that NHIF has faced for a long time,” Harry Kimutai stated
During the handover, the anti-graft agency also released findings following an examination of systems, policies, procedures, and practices of work at the NHIF. EACC found out that corrupt officials collaborated with healthcare providers to siphon funds from the organization.
Some key departments in the defunct National Health Insurance Fund are inadequately staffed, providing opportunities for bribery and extortion, this is according to a report released by EACC.
For instance, the call centre relied on one staff to answer medical-related enquiries while 11 case management staff were relied upon to respond to over 5,000 preauthorisation requests received daily.
This, the report says has created a huge backlog of preauthorisation necessitating follow-ups by health facilities and individual beneficiaries.
In addition, Quality Assurance staff stationed in the branches were found to be inadequate to cover the demand for clinical surveillance, facilities assessment and claims processing workload.
Further, some three NHIF staff irregularly amended member details occasioning a loss of KES 29.9 million to the fund on 14th July 2022. Twelve specialized Services were also added to one health care provider and privileged transactions were carried out by unauthorized users in the e-claim system assignment.
In some instances, officers transferred to other branches undertook duties under the purvey of the previous workstation since no replacement had been done.
Other malpractices recorded included amendment to members and health care provider data and processing of transactions without approval workflows. There was failure to promptly migrate user system profiles for transferred staff and sharing of system access credentials between staff and interns.
EACC chairperson David Oginde said that they will support the Board in sealing the identified corruption loopholes and systemic weaknesses even as investigations on the criminal aspects continue.
“Any resources that were stolen from or through the NHIF will be pursued until they are brought back or the people who were involved are brought to book. Where individuals are found to have illegally benefitted from public funds, the Commission will, besides recommending prosecution, file civil suits to recover the lost funds,” he said.
Dr. Oginde also mentioned that the Commission anticipates the Social Health Authority’s management to devise an action plan based on the report within 30 days. The Commission will oversee the execution of this plan.
