NHIF dismisses non-payment allegations

August 22, 2017 5:09 pm
The Chief Executive Officer Geoffrey Mwangi told a news conference Tuesday that the medical insurer has not received any formal complaint from any of its over 9,000 partner health institutions/JEREMIAH WAKAYA

, NAIROBI, Kenya, Aug 22 – The National Hospital Insurance Fund (NHIF) has refuted claims of non-payment of funds owed to health facilities offering medical services to its members.

The Chief Executive Officer Geoffrey Mwangi told a news conference Tuesday that the medical insurer has not received any formal complaint from any of its over 9,000 partner health institutions with regards to the settlement of claims, adding that NHIF continued to meet contractual obligations with all partner hospitals, both private and public.

“We deal with specific facilities depending on the type of the service they offer. In the course of business, there could be issues which we iron out as per the signed contracts. Any issues are usually resolved during consultative meetings,” Mwangi who is also the NHIF Board Secretary said.

He however emphasised that there was an increase in the number of fraudulent claims being lodged, a situation that has resulted in some cases, prolonged clearance of claims which would normally have taken 21 days.

Mwangi said the emergence of false returns by some health facilities meant that an in-depth analysis had to be put in place to guard against embezzlement of resources.

The Chairperson of Kenya Association of Private Hospitals (KAPH), Abdi Mohamed, who accompanied Mwangi during the briefing also dismissed the claims saying the insurer has endeavoured to pay all hospitals promptly.

“NHIF is the only insurer I’ve seen paying promptly within a month or two depending on how claims are submitted. If your claims have an issue, that is they’re fraudulent, definitely, you’ll not be paid,” the KAPH head proclaimed during the press conference also attended Kenya National Union of Teachers representative in the NHIF board of directors Mudzo Nzili and his Central Organization of Trade Unions counterpart Akelo Misori.

Mwangi and Mohamed who spoke after a stakeholder engagement with among others the Kenya Conference of Catholic Bishops and the Christian Health Association of Kenya said NHIF was committed to continuing engaging all service providers in order to enhance service delivery.

NHIF has some 2,239 health centres nationwide offering outpatient services, 1,314 offering inpatient services and 5,012 offering free maternity services.

The fund also supports 73 dialysis centres, 59 radiology centres, 182 eye clinics, thirty-three oncology centres and twelve drug rehabilitation centres.

The insurance fund which hit 6.5 million subscriptions in June this year, up from 6.1 million in June 2016 has however faced accusations of non-remittance of payments to listed hospitals, a situation that is said to have led to a number of patients with medical access cards being turned away.

With an estimated national average of 24 million beneficiaries, the largest medical insurer in the country has had to contend with challenges arising from the delayed payment of claims, even as some hospitals offering critical services such as dialysis continued to voice concerns over outstanding bills.

During NHIF’s 50-year celebration in June, its chief executive said the fund was targeting about 12 million Kenyans in the informal sector as it aimed at expanding the insurance programme.

About Sh34 billion was raised in the period ending June with Sh21 billion being paid to hospitals and Sh5.9 million incurred in internal expenses.

The fund also enlisted other services such as kidney transplants, chemotherapy for cancer patients and Magnetic Resonance Imaging (MRI) scans.


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