The caretaker board said on Friday that the two firms would remain suspended until investigations were complete/FILE
The caretaker board said on Friday that the two firms would remain suspended until investigations were complete.
NHIF Caretaker board acting chief executive officer Adan A. Adan has advised members of the scheme currently capitated under the two service providers to seek alternative outpatient Services.
“Civil Servants currently capitated under Clinix healthcare limited and Meridian healthcare centres are advised to seek alternative outpatient services from the list of service providers which appears on the NHIF website www.nhif.or.ke,” Adan stated adding that a full list of service providers available to the affected members of the scheme would be published in the print media on Sunday 17 June and Tuesday 19 June.
“The list has also been released to all heads of human resource management departments in all ministries and the Union of Kenya Civil Servants,” he said.
The civil servants scheme has 221,000 members of which 56,000 were under Clinix healthcare limited and 32,000 under Meridian healthcare centres.
He said the board would circulate a new list of health facilities for civil servants’ scheme starting July 1.
“The current contract is supposed to go up to 30th June. For this short period of two weeks, we shall go for fee for service, then from 1st July we will go back to capitation.
Meanwhile, the scheme for civil servants has run into a fresh row following a brewing disquiet over accreditation of new providers without regard to procurement rules.
The new caretaker board has already listed new health providers to carry on the scheme following the suspension of transactions with Clinix and Meridian health facilities over the contentious Sh4.3billion medical scheme.
The acting NHIF CEO released a list of 142 clinics and health centres scheduled to offer services to civil servants.
A memo signed by him seen by Capital FM News states in part: “All Civil Servants and Disciplined Services members under Outpatient Healthcare Medical Cover are invited to select afresh facility of choice for themselves and dependants for the period 1-07-2012 to
30-09-2012.”
The new forms are supposed to be filled and returned to NHIF by June 28, 2010.
Conspicuously missing out in the new list are Clinix and Meridian health facilities that have been under focus over the alleged manner in which they were allocated the services in the first phase of the scheme.
This came even as the two health providers indicated that the payment list allegedly presented to the Parliamentary committee on health investigating the NHIF civil service medical scheme was not factual.
The two providers who now say they are still providing services to civil servants without payments are accusing the NHIF of breach of contract.
The two health providers say the hurry with which the new board was bringing on board new providers to take their place was suspect since investigations into the scheme were not complete.
“The caretaker board has never given the providers audience since they were appointed while the providers continue to offer services to civil servants without pay,” reads part of the correspondence.
The providers have said not every clinic under the service providers’ establishments was allocated money contrary to earlier reports since this was not expressly stated so in the contract with the government insurer.
Suspended CEO Richard Kerich has since disowned the list and the two providers now want investigations undertaken to ascertain the drafters of the fake list that the parliamentary committee used to make its recommendations.
Meridian specifically complained that the capitated amounts do not tally and has only selected outlets leaving others that the civil servants have been receiving services from.
“It is through this fictitious list that an impression was created that there was money irregularly paid to two service providers; Clinics and Meridian on non-existent clinics,” the health provider said it its complaints to the new board.
For instance, Meridian indicated that two of its outlets were not listed but they had recorded the largest number of patients who have sought treatment under the scheme.
It cited Meridian Equator at a total of 2,842 patients and Donholm meridian which has seen 1,245 treatments. It also said Kakamega and Machakos outlets were also not in the list.
A letter also in the report tabled by the Director of Medical Services Francis Kimani indicates that the Medical Practitioners and Dentists Board (MPDB) inspected the private clinics following allegations thatmoney meant for the rolling out of outpatient medical scheme for civil servants had been allocated to ghost clinics.
A memorandum on the registration and licensing dated May 30, carried out by the MPDB confirms that Clinix and Meridian facilities, which were licensed this year were operational.
The board has registered 19 Meridian Facilities with details of location, date of registration and medical personnel in charge. The Board has further licensed 68 Clinix facilities for the year 2012 .
Under the capitation scheme, payment is done upfront, a complaint the providers has lodged with the new board. A fixed amount of money is given by the insurer to offer services to a specific number of people
They also claim that some departments at NHIF were not involved in the recruitment of the new providers.
In the list of new providers, the two hospitals are not listed while most of the new entrants are health providers called Afya Loyal and Accasia Medical.
Those who were initially listed in the Clinix and Meridian hospitals have been asked to seek the services at Kenyatta National Hospital, Mbagathi District hospital and other near health facilities for those outside Nairobi.
This is also despite protest from the Union of Civil Servants of Kenya (UCKS) who has indicated that they are comfortable with the de-listed providers.
“Currently, our members in Nairobi are being served by two private providers-Clinix and Meridian- which have both proved convenient in their service delivery to our members as they are easily accessible due to their locations within the city,” said UKCS Executive Secretary Wilson Asingo in a letter acting Chief Executive of NHIF.
The interim NHIF Chief Executive Officer was appointed following he suspension of the former board alongside the then head of the scheme Richard Kerich.
According to the contract signed between the providers and the NHIF, no clause shows any payments allocated to clinics or individual outlets.
The contract clearly stipulates that the “the healthcare provider shall be paid under the capitation payment method whereby they shall be allocated an agreed amount of Sh14, 250 for M + <4 (member +4 dependents)” It continues to say that “after the initial payment, subsequent payments shall be made after submission of returns as in NHIF 18C Annex V.” Capitation schemes have been successful in Germany, , Netherlands, Korea and France. In developing countries, Taiwan, Thailand and South Africa are using it. The parliamentary committee on health has also gone in record despite the many challenges facing the scheme to recommend that the government must ensure its continuity. The new scheme covers outpatient and inpatient medical cover and it came into effect in January with the first quarter ending in March. The scheme is supposed to run until June when the government is expected to renew the contract for one year.
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