NHIF recovers 6.46bn/- from fraudulent claims

THE National Health Insurance Fund (NHIF) has recovered a total of 6.46bn/- from 9.74bn/- which was paid to some health facilities through fraudulent payment claims.

Minister for Health, Ms Ummy Mwalimu spoke of the recovered money in Parliament on Friday while tabling the 2023/2024  budget estimates for her docket where she asked  lawmakers to endorse 1.234tri/-  for  recurrent and development expenditures.

She said that between July 2022 and April  this year, the Fund conducted 311 investigations of fraud indicators and identified illegal claims amounting to 9.74bn/- paid to service providers who presented false claims to the health scheme.

She said until April 30, this year a total of 6.46bn/- had been recovered, noting that the deduction of the remaining amount was ongoing through the claims presented by the respective health facilities.

She noted that the Fund has continued to strengthen the fight against fraud which, to a great extent, is being done by dishonesty facilities, members and employers.

“Stringent measures have continued to be taken against the accredited health facilities being involved in fraud including terminating their contracts with the Fund, including submitting names of employees to their professional boards,” Ms Mwalimu said.

The minister further said that until April this year, the Fund had terminated contracts with 38 health facilities and presented names of 131 workers to their professional councils for further actions.

The minister called upon all service providers and members to refrain from fraudulent acts in order to make the Fund sustainable.

Ms Mwalimu explained that despite the challenge the Fund   has continued to contribute in medical costs whereby in 2021/2022 a total of 674.25bn/- was paid to health service providers compared to 540.55bn/- paid in 2020/2021.

She noted that between July 2022 and March 2023, a total of 557.82bn/- was paid to health services compared to 382.14bn/- paid during the same period in 2021/2022.

“Statistics indicate that NHIF funds currently contribute 80 per cent of health facilities’ revenue in the country,” she noted.

The minister said the Fund has established an electronic system for processing claims lodged by health service providers to ensure that they are paid on time.

The minister on the other hand informed the Parliament that in carrying out their duties efficiently, her ministry and the Medical Stores Department (MSD) have distributed health commodities worth 727.7bn/- to 7,538 health care centres for the period between July 2022 and March 2023.

According to the minister, this is equivalent to an increase of 19.7 per cent compared to the July 2021 period until March 2022, where the distribution of health commodities was worth 608.1bn/-.

“I would like to inform your Parliament that from this financial year (2022/23), MSD has started distributing medicines to health care centres  after every two months, which means six times a year from the previous three months, which was four times a year,” she said.

She said this has reduced the shortage of medicines to the health centres which was a major challenge.

She further said that her ministry, through the MSD, has established two health product factories which make two types of masks, the ordinary surgical masks and N95 masks.

She said that the masks produced in the factory have satisfied the needs of the whole country and reduced the price of masks from the previous 1,600/- to 500/ per mask which has helped to save 3bn/-.