NHIF accuses health facilities of fraud

Dodoma. The National Health Insurance Fund (NHIF) yesterday accused owners of some health facilities of submitting fraudulent payment claims warning that this was sabotaging the government’s efforts to expand health insurance coverage.

NHIF Director General Bernard Konga told Parliament’s Public Accounts Committee (PAC) in Dodoma that accredited health facilities that provided low cost health services to clients were now claiming inflated amounts in bills sent to NHIF.

Currently, only 28 per cent of Tanzanians are enrolled in health insurance schemes, according to a report released on Wednesday by Twaweza, titled Health Check: A Citizen Diagnosis of Health Sector Challenges.

NHIF is now struggling to ensure that at least 50 per cent of all Tanzanians are on medical cover by the year 2020, but according to Mr Konga, efforts to achieve higher coverage were being hampered by dishonest health facility owners, among other challenges.

“Some healthcare providers are dishonest. They claim inflated amounts for services they offer...much higher than the actual cost of service provided. We are determined to do away with them.”

Mr Konga said NHIF could be incurring losses in billions of shillings through the fraudulent claims but the amount of money lost was yet to be ascertained.

To counter the problem, the institution has now embarked on a nationwide operation seeking to terminate contracts with accredited health service centres which have been found to forge claims on the service delivery refunds.

It was also relying on technology in an effort to seal the loopholes of corruption and mismanagement.

Mr Konga told the PAC that NHIF was planning to introduce new advanced electronic cards for its members from January next year. He said it was a timely initiative to contain increasing the misuse of the funds if the health service coverage cards were widely used among the members.

“The envisaged new high-tech cards will include a special chip inside which will automatically channel the entire user’s information to our headquarters. We are also enhancing our ICT department in support with experts from the e-government to ensure professional and advanced services,” he said.

For her part, NHIF board chairperson Anne Makinda said the fund was now working in line with the national and global agenda of ensuring Universal Health Coverage, according to goal 3 of the Sustainable Development Goals (SDGs).

It’s now more than a year since the Minister of Health, Community Development, Gender, Elderly and Children, Ms Ummy Mwalimu, announced that a bill would be tabled in Parliament as part of the country’s plan to introduce the mandatory health cover. It hasn’t been tabled yet.

Universal health insurance is seen as the best way to help people out of high cost of paying for health services.

During the PAC meeting in Dodoma yesterday, Ms Catherine Lughe (Special Seats MP-Chadema), challenged NHIF to consider more private health facilities in their funding accreditation.

“I remain hesitant that giving a condition of three years of successful operations as a key qualification to be accredited for private health centres to stand a chance to benefit from NHIF’ support locks them out from the crucial opportunity,” she argued.

The MP’s concern stems from the fact the government has been asked by private health stakeholders not to sideline them.

The government has been asked not to maintain monopoly of Universal Health Coverage (UNC) strategies, whereby it relies on the NHIF for implementation, sidelining the private health sector.

Mr Konga has until recently assured the private health stakeholders that there was room for discussion on how the NHIF would partner with the private insurance stakeholders.

PAC chairperson Nagenjwa Kaboyoka members of the NHIF board of directors to adhere to the directives issued by the CAG and other positive inputs aired by legislators during the meeting.

Additional reporting by Syriacus Buguzi