St. Peter's Orthopaedic hospital cleared in NHIF fraud probe

This Kiambu-based hospital was initially implicated in an audit report alongside Jekim Medical Centre of Meru and Nairobi's Eastleigh-based Hospitals-Beirut Pharmacy and Medical Centre.

However, after a thorough investigation including audits and reviews of billing records, the Health Committee determined that St. Peter's had adhered to all guidelines and protocols set forth by the national insurance health cover.

The committee, chaired by Endebess MP Robert Pukose, found no evidence of deliberate wrongdoing or fraudulent activity by St. Peter's Orthopaedic and Surgical Specialty Centre.

Consequently, the National Insurer has been directed to lift the suspension of the hospital and pay all outstanding verifiable claims. The hospital administration expressed relief at the findings and reaffirmed their commitment to maintaining transparency, integrity, and high-quality healthcare services.

In contrast, the investigation uncovered significant irregularities in other health facilities. Some hospitals had fraudulently billed the NHIF and colluded with the NHIF’s Claims Management Division, allowing beneficiaries to demand refunds for money they had not spent.

The Health Committee found flaws in the licensing and accreditation process, which resulted in some facilities being wrongly categorized at higher levels than their actual capacity, infrastructure, and staffing warranted.

The committee recommended the closure of several hospitals, including Joy Nursing and Maternity Eastleigh Limited, Amal Hospital Limited, and Beirut Pharmacy and Medical Centre.

Joy Nursing and Maternity was found in a residential building with inadequate infrastructure, no contractual agreements with claimed orthopaedic surgeons, and a lack of essential medical units.

Amal Hospital was closed during the committee's visit, despite neighbours reporting it was operational. Beirut Pharmacy and Medical Centre was deserted, with no patients, furniture, equipment, or staff present.

Lawmakers have directed the Directorate of Criminal Investigations (DCI) to investigate potential collusion between service providers and the NHIF’s Claims Management Division. The investigation will focus on the division's manager and those involved in pre-authorizing overseas treatment, with a three-month deadline for the probe.

Additionally, the Health Committee suggested lifting NHIF’s suspension on Afya Bora Hospital Annex and paying its outstanding claims. However, they recommended disciplinary action against NHIF staff involved in claims verification, including claims managers, the branch manager, and quality assurance officers at the Mwea branch.