Auditor General Nancy Gathungu Uncovers Millions of Discrepancies in NHIF Claims Payments
- Auditor General Nancy Gathungu revealed that hospitals billed KSh 447,122,141 to NHIF in the 2022/2023 financial year
- However, the insurer paid claims totalling KSh 814,893,467, resulting in an unexplained variance of KSh 367,771,326
- Gathungu said NHIF's management explained that the variation was attributed to typos made by hospital clerks when entering bill amounts into the electronic claim system
TUKO.co.ke journalist Japhet Ruto has over eight years of experience in financial, business, and technology reporting and offers deep insights into Kenyan and global economic trends.
Auditor General Nancy Gathungu has flagged discrepancies amounting to KSh 367.7 million in the payment of claims by the National Hospital Insurance Fund (NHIF) in the 2022/2023 financial year.
Auditor General Nancy Gathungu identified discrepancies in NHIF payments. Photo: Ndindi Nyoro. Source: Twitter
How much did hospitals bill NHIF?
During the period under review, Gathungu revealed that hospitals billed KSh 447,122,141.
However, the insurer paid claims totalling KSh 814,893,467. This resulted in an unexplained variance of KSh 367,771,326.
"The statement of profit or loss and other comprehensive income reflects total benefit expenses of Kshs.70,886,855,120 for claims paid to empanelled and contracted health facilities. However, review of payment data revealed that the hospitals billed KSh 447,122,141 against claims paid amounting to KSh 814,893,467 resulting to unexplained variance of KSh 367,771,326," Gathungu stated in her report.
What was NHIF's response?
Gathungu said NHIF's management explained that the variation was attributed to typos made by hospital clerks when entering bill amounts into the electronic claim system.
However, there was no proof matching the amount billed to the claims paid or refund requests for overpayments.
"Although management attributed the variance to typing errors made by hospital clerks while inputting bill amounts in the E-claim system, there was no evidence of reconciling the billed amount to claims paid or requests for refunds for overpayments," the auditor general stated.
How Gathungu exposed another scandal
President William Ruto's administration was also put on the spot for over KSh 15 billion collected under the Gava Mkonini platform.
Details in Gathungu's report flagged variances in the receipt of revenue collected via eCitizen.
The report for the year ending June 30, 2023, showed that KSh 15.5 billion was collected during the financial year 2022/23, but receivers of the revenue could not be confirmed.