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National Health and Insurance Fund (NHIF) acting Chief Executive Samson Kuhora yesterday found himself in a difficult position after MPs accused him of being at the centre of the fraudulent claims and payments made to various hospitals.

Kuhora who had appeared before the National Assembly’s Health Committee that is investigating the rot at NHIF accused him of being part of those who approved fraudulent claims lodged by various hospitals.
So hot was the meeting that committee members claimed that Kuhora was promoted to the position of Acting CEO to cleanse the rot he left in the department prior to his appointment four months ago.

The MPs led by the chairperson Robert Pukose (Endebess), Jaldesa Guyo (Moyale), and Duncan Mathenge (Nyeri Town) told Kuhora that he cannot delink himself from the mess unless he provide satisfactory answers on how the loss was incurred.

They also claimed that some officials from NHIF had now colluded with hospitals outside the country, such as those in India, in a well-orchestrated scheme to loot from the public coffers.

Pukose said it is worrying that fraud was being orchestrated from the CEO’s office.
“When fraud is being orchestrated from your office then it is questionable,” he said

Guyo told Kuhora to shed light on how doubtful claims were generated and paid without the fund doing its due diligence.

“All that we are investigating lies with the CEO and he needs to come clear on the facilities that were charging 20 or more times than the approved rate. I feel like you might have been elevated to acting CEO to conceal what you have been doing… Unless you prove otherwise, in your position three months ago, what we are investigating is what you were doing before being elevated,” he added.

Maina demanded to know whether the fund only concentrated on the authentication of the members yet he was aware that the fraud was being done by service providers.

“Why did you only spend money and time on coming up with the authentication of the members and not the service providers? Please tell us were you at the centre of this scheme so that you designed a system that will favour the health facilities,” he said.

Maina also sought to know whether the institution had conducted market research on the prices of drugs which would then inform the prices they pay following revelations that the fund is paying more than double what should be paid for the drugs.

But speaking in his defence, Kuhora explained that he was not in the case management department that authorises payments as he only served in the data analytics department.

“Prior to my promotion, I worked in the data analytics department and did not work in the case management department which is in charge of claims payments approvals,” stated Kuhora.
And to further exonerate himself, Kuhora said that NHIF had already taken action against all those involved in the alleged fraud by suspending contracts with six hospitals for a period of 90 days.

He explained that investigations into two health facilities namely Beirut Pharma and Amal Hospital in Eastleigh had been completed after it was established that they had been involved in fraud while the other six facilities, he said, investigations are still ongoing with a report on the same expected within three months from July 16, 2023.

“NHIF has taken decisive action by closing health facilities found to be engaged in fraudulent activities, safeguarding beneficiaries and preserving the integrity of the healthcare system. The closure of the health facilities involves meticulous investigations and adherence to legal requirements, ensuring that due process is followed,” he said.

Meanwhile, pharmacists and chair of the Kenya Pharmaceuticals Distributors Association Dr Kamamia Murichu who had been invited by the committee to offer technical advice on the matter told the committee that lack of internal controls at NHIF to ensure verification of the amounts in claims had led to the alleged loss of public funds.

He alleged that there is gross abuse of the claims process at NHIF because many facilities charge exorbitant prices for drugs that they did not administer to patients.

He said: “If a facility prescribes generic drugs to a patient for instance, it in turn claims for the price of an original drug which is way higher.

It appears that there is no one from NHIF who bothers to verify the price of drugs as contained in the claims and that is how they end up paying out billions.”