Senate to investigate alleged collusion in Ksh 6.3B medical contract for police

The investigation follows reports of delayed or denied compensation for police officers injured in the line of duty, as stipulated in the contract between the NPS and the National Health Insurance Fund (NHIF), the former national health insurer.

Eliud Kinuthia, chairperson of the National Police Service Commission (NPSC), testified that only a small number of police officers have been compensated, with the majority of claims being either rejected or delayed without clear justification. Kinuthia further stated that NHIF has consistently ignored officers' complaints when they raised concerns about the delays and rejections.

According to Kinuthia, only 937 claims, valued at Ksh.709 million, have been settled so far. Meanwhile, 240 claims worth Ksh.240 million have been rejected by the insurance companies.

In addition, 161 claims, totalling Ksh.108 million, are still being processed, 106 claims are awaiting proper documentation, and 422 claims worth Ksh.444 million are under internal review by NHIF, which has since been renamed the Social Health Insurance Fund (SHA).

“They are targeting a very vulnerable group that lacks unions,” Kinuthia told the Senate Security, Defence, and Foreign Relations Committee. “NHIF can be arrogant toward us, and we have nowhere to turn. We’ve been disadvantaged because we have no union to represent us, and we can’t raise our voices, so we suffer in silence.”

The confusion began when the National Police Service signed a contract with NHIF to provide compensation for officers injured on duty. However, due to NHIF's lack of capacity, the police service entered into a separate agreement with private insurance companies to underwrite these claims.

According to the NPSC, the private insurance companies are now creating unnecessary hurdles in processing the claims for injured officers.

Augustine Wafula, claims manager at the Social Health Authority (SHA), explained that the issues stem from discrepancies between the contract signed by the NPS with NHIF and the separate agreement between NHIF and the private insurers.

“There are two contracts: one between NHIF and the police service, and the other between NHIF and the co-insurers,” Wafula told the committee. “One of the reasons given for claim rejections is that an officer was allegedly assaulted while sleeping in his house, which the insurers argue is not covered by the contract.”

However, this explanation was dismissed by the NPSC, which insisted that the co-insurers are not recognized by them.

“As the employer, we do not know these co-insurers; they are unknown to us,” Kinuthia stated. “We have no arrangements with them. But we are glad that NHIF has brought them in. NHIF should take full responsibility for whoever they included in this contractual arrangement.”

Kinuthia added, “They are telling us that the officer was attacked while sleeping at home, and so they argue that he was not working at the time. I want to categorically state that a police officer does not sleep. We simply rest because we are on duty 24 hours a day.”

The Senate committee, led by Chairperson William Cheptumo, promised to fully investigate the matter and ensure that injured officers are compensated. Cheptumo placed the blame on the management of SHA, saying that the agency was responsible for the current mess.

“The real enemy here is SHA, or NHIF,” Cheptumo stated. “They may hide behind the fact that they are not answerable to the Insurance Regulatory Authority, but I assure you, they will be answerable to us. We will call all the co-insurer companies here to demand answers as to why they are not paying the claims.”

So far, a total of 1,966 police officers have filed claims for compensation due to injuries sustained while on duty.