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NHIF stops paying bills at hundreds of private hospitals

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The National Hospital Insurance Fund (NHIF) has stopped settling diagnostic test bills from hundreds of private service providers it accuses of making fraudulent claims.

NHIF said the decision was informed by the realization that the facilities have been making claims for services not rendered, thereby raising the level of fraudulent claims in the fund.

It said Thursday that it had suspended paying for diagnostics tests such as MRI and CT-scan at hundreds of small and medium-sized private facilities whose list it plans to publish in the coming weeks.

“We have suspended the programme with these hospitals since they are fraudsters,” said NHIF CEO Geoffrey Mwangi, adding that a full list bearing the names of the culpable facilities would soon be published. “We had to look for a way to stop this daylight thievery.”

NHIF said it had taken legal action against some of the service providers such as Nairobi-based German Medical Centre.

Members can, however, access the diagnostic tests at reputable private hospitals such as Aga Khan, Nairobi and MP Shah under the NHIF outpatient scheme.

To access the service, patients must obtain a pre-authorisation letter from the hospital, which will be sent to NHIF for approval.

The NHIF covers MRIs up to a maximum of Sh. 15,000 per session while settlement of CT-scans are capped at Sh. 8,000.

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