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Docs, pharmacies on the spot over `false` NHIF claims

12th May 2012
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National Health Insurance Fund (NHIF)

Some service providers, including doctors and owners of pharmacies, have been pointed out as among those who sabotage the National Health Insurance Fund (NHIF) by stealing cheque numbers of members of the Fund and using them to lodge false claims.

This was revealed recently following complaints from some members, especially teachers, who had noted that their membership numbers were being used to make false claims to the NHIF while they had not used the services.

One teacher, Evelyine Wambura, claimed to have noted the malpractice after NHIF called her to ask her whether she had received health services on certain dates as had been filled in by some  pharmacies and hospitals, especially after NHIF had noted serious  discrepancies in the ages of the beneficiaries filled in.

“For instance, they showed that on March 8 I used the service at Mafiga Hospital, while on that day I was taking part in the World Women's Day. They claimed that I was treated of typhoid and a total of 76,000/- was billed, and that I was 48 years old while I'm now 50. I'm not the only one, there are several other teachers whose names were billed 56,000/- and another 77,000/-. We need to be careful," said Magreth Mpanda, a Mwere Primary School teacher.

Evelyine Wambura from the Education Department  in Morogoro municipality said that NHIF also had noted that  there were two names of people whom she did not know whose names had been billed against her membership.

Addressing reporters in his office regarding the sabotage, NHIF monitoring officer in Coastal Zone Salum Adam called on members not to agree to be used to make false claims, adding that they would continue to verify the bill claims.

He said in the exercise a number of fraudulent claims cropped up, adding that it was easy to note them after seeing a sudden increase in a bill, sometimes to the tune of millions of shillings.

“We are still investigating how they come to own these membership identity cards. It's possible there are members who
collude, use the documents and information to make false claims. In some hospitals we came across these identity cards," said Salum.
 
He said that the Fund has already arrested six people suspected of engaging in the malpractices, including three medical doctors who colluded with pharmacies, and one owner of a pharmacy, adding that investigations were going on.

SOURCE: THE GUARDIAN
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