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Acting NHIF boss is held accountable by CS Health for the Sh1.6 billion claims fraud.

Acting NHIF boss is held accountable by CS Health for the Sh1.6 billion claims fraud.

Susan Nakhumicha, the health cabinet secretary, sought to blame the National Health Insurance Fund’s (NHIF) interim CEO for the Sh1.6 billion claims controversy yesterday.

Nakhumicha said yesterday during her appearance before the National Assembly Committee for Health that Dr. Samson Kuhora, the acting CEO, was in charge of the claims department, which is in charge of processing the payments in issue.

Robert Pukose, the committee’s chairman, questioned Nakhumicha about whether she had enquired about Kuhora’s past position before elevating him. Nakhumicha responded that she had received a thorough briefing from her officers.

“The senior-most executive was the acting CEO. The alternative, which would have taken a bit longer, was to hire from outside, according to the CS.

It would have taken longer to bring in a different person or hire someone from outside because of the recruitment procedure, she continued.

Pukose disagreed with the CS, claiming that the CEO position might have been filled by more senior staff members from the Ministry and NHIF. Pukose asserted, “You don’t pick someone who has overseen claims at NHIF to go out and cover up for himself.”

When Kuhora was chosen as the interim CEO, he was the Head of Benefits and Claims.

Nakhumicha further disclosed that one of the medical centers suspended due to its involvement in the fraud performed more operations than all of the nation’s main hospitals put together.

The CS described the issues plaguing the Fund as perplexing and added that an audit, which she has instructed the board to start, will disclose more.

The CS stated that the health facility in question was handling more surgery cases than top hospitals, including Kenyatta National Hospital, to support her decision to suspend branch managers of the NHIF after rogue hospitals allegedly stole millions of shillings through dubious medical camps that targeted elderly patients.

One of the facilities I suspended is this one. According to Nakhumicha, it performed more procedures than the KNH, Moi Referral, and the best private hospitals combined.

The CS reported that she had given the facilities that were suspended 24 hours to remove the patients. Nakhumicha claimed that by suspending the operations, a favorable climate for inquiries would be created.

“Why employ branch managers? According to Nakhumicha, branch managers are in charge of managing, monitoring, and assessing the facilities that fall under their purview and informing the headquarters of any problems that arise.

“When claims are made, branch managers review the claims before they reach the HQ,” she said. “I’ll stick to my guns, and I’ll take the lead. We might make some errors, but we’ll grow from them and keep going. However, there is no need to put off making these choices. They must be removed.

The committee disagreed, stating that it was “too little, too late” and that the decision to suspend the branch managers was a mistake.

However, the CS urged the committee to back her initiatives, stating that they had to start somewhere if they were to solve the corruption at NHIF.
She also urged investigative organizations to carry out a complete investigation.

However, the CS urged the committee to back her initiatives, stating that they had to start somewhere if they were to solve the corruption at NHIF.

She also urged investigative organizations to carry out a complete investigation.
“By the time we make final decisions, they will be based on the facts brought out by the investigations,” she stated.

The CS stated that the scams involving the Kenya Medical Supplies Agency (Kemsa) and the National Health Insurance Fund (NHIF) in particular need to have those responsible held accountable.

Even though we have processes in place, the same individuals continue to misuse public funds. As a result, she continued, “we must deal with the offenders.” Before the public exposé, according to Nakhumicha, her Ministry had started looking into the NHIF scam.

The CS said that the six facilities that were singled out in the expose were not the only ones affected by the flaw in the NHIF payment claims system.

“We have a serious issue. It is surprising that more than 60% of NHIF funds go to for-profit facilities. The CS stated, “I am still not persuaded that smaller private clinics perform more surgery than KNH and all the public facilities put together.

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