A preliminary investigation by the National Assembly Committee on Health has revealed collusion between health facilities and schools in falsifying data under the EduAfya insurance scheme. The committee, led by Chairperson Dr. Robert Pukose, discovered discrepancies between the number of pupils treated in hospitals and the registers provided by schools or referred by schools for medication. There are suspicions of fraudulent claims, with some facilities allegedly inflating figures.

The committee is inspecting selected health facilities in Uasin Gishu County, and its findings suggest possible collusion between schools and health facilities to manipulate the EduAfya insurance scheme. During their visit to Mediheal Hospital and Fertility Centre in Eldoret, the committee found discrepancies in the data, prompting concerns about the integrity of the claims made under the insurance scheme.

The investigation was initiated last year following a Nation exposé on fraudulent claims submitted by some health facilities in collaboration with NHIF officials. The committee aims to scrutinize facilities that have received substantial funds from the National Hospital Insurance Fund (NHIF) and evaluate the authenticity of the claims.

Chairperson Pukose revealed instances of facilities shutting down upon learning of the committee’s visit, raising suspicions of misconduct. The report, expected to be tabled in parliament in the coming weeks, may include recommendations for possible prosecution, involving the Directorate of Criminal Investigations (DCI) and the Ethics and Anti-Corruption Commission (EACC).

The committee’s inspections cover facilities in Nairobi, Kirinyaga, Nakuru, and Uasin Gishu counties. Questions have been raised about the criteria for assigning different statuses (ranging from Level 1 to Level 5) to health facilities, as some do not seem to meet the requirements for their designated levels.

The investigation comes at a time when Kenya is transitioning from the NHIF to the Social Health Insurance Fund (SHIF). While the deadline for NHIF contributions is set for December, Health Cabinet Secretary Susan Nakhumicha indicated that Kenyans would start contributing to SHIF this month after the completion of public participation forums.

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