NHIF faults forgery in hospital claims

Tanga. The National Health Insurance Fund (NHIF) in Tanga has warned government health facilities over an increase in forged claims, saying that they could jeopardise the effectiveness of the fund in helping people to get quality low-cost health services.

Speaking in Tanga, NHIF Tanga regional manager Ali Mwakababu said that although there was a general efficiency in payment of claims in 2017/2018 compared to the previous year, forged claims and delays in presentation of NHIF claims remained some of the nagging weaknesses in the delivery of services in the region.

“Some facilities under district medical officers (DMOs) send these claims over 60 days after the respective month,” he said, adding that, this was despite the fact that NHIF had installed electronic systems in a significant number of facilities.

Mr Mwakababu said that there was an increase in NHIF claims payments by 4 per cent (Sh182.5 million) to local government authorities in the year 2017/18 compared to the previous year and by 76 per cent (Sh1.14 billion) to the referral hospitals in the same year.

The fund paid claims totaling Sh6.37 billion to government health facilities out of which local government authorities were paid Sh3.74 billion while Sh2.62 billion was paid to Bombo Regional Hospital.

The previous year a total of Sh5.05 was paid as payment claims to government facilities in the region.

Other weaknesses or challenges that hinder effective delivery of NHIF services include shortage of lack of staff in rural facilities, lack of water and power in rural facilities, lack of laboratory and medical equipment, facility staff forging patient signatures and presentation of claims that have not been stamped or have not yet been signed.

The previous year a total of Sh5.05 was paid as payment claims to government facilities in the region.

Other weaknesses or challenges that hinder effective delivery of NHIF services include shortage of lack of staff in rural facilities, lack of water and power in rural facilities, lack of laboratory and medical equipment, facility staff forging patient signatures and presentation of claims that have not been stamped or have not yet been signed.