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The economy loses Sh33 billion every year to medical fraudsters, an association linked to rural private hospitals has said.
Rural Private Hospitals Association of Kenya (Rupha) chair Brian Gichenga yesterday said the amount of money translated to 10 per cent loss of Kenya’s Sh400 billion healthcare expenditure.
“One of the main concerns that is there in the health sector in the country is the losses that we as a country incur because of medical fraud. By 2019, according to estimates by the Association of Kenya Insurance shows that Kenya loses Sh30 billion every year on false claims or fraud within the medical sector,” he said.
Gichenga was speaking at the opening of the association’s two day convention at a city hotel.
Complex methods
He said the fraudsters use complex methods, where hospitals and healthcare providers collude with clients to falsify claims, or hospitals generating false claims, or insurancecompanies denying patients access to services for health premiums.
“We have all these types of corruption which we have sought to address as an association with the launch of our anti-medical fraud policy when the world is marking the International Anti-corruption Day,” said Gichenga.
He said the policy will be adopted in all Rupha’s 250 health care facilities in 43 counties, and will be the main business anchor between Rupha members and insurance companies.
It has a provision for a call centre for whistle blowers to anonymously report suspected cases of medical fraud, an idea Gichenga said will create confidence among the insurance sector and patients to engage the facilities within the Rupha network.
The event also witnessed the launch of the Rupha Afya Medical Card, which will be piloted across 18 facilities in seven counties for the next three months.
Gichinga said lessons learnt from the pilot project will inform their national roll-out set for June 2022, with expectations the scheme, with a package as low as Sh1,000 benefiting a family of four, will qualify nine million out of 18 million Kenyans in the rural and economically underserved area that seek medical services in their facilities access quality health care.
Anti-fraud policy
Speaking during the occasion, Judith Langat, a representative from the Ethics and Anti-Corruption Commission (EACC)lauded the association for launching an anti-fraud policy, which she said was one of the strategies the commission encourages organisations to do.
“By doing this, you are committing to fight corruption and ensuring that quality services are provided for the mwananchi,” said Langat.