Senators investigating fraud by private insurance companies in the Sh6.3bn police contract » Capital News
NAIROBI, Kenya, Nov 15 – Senators have initiated investigations on medical fraud following links of collusion between Social Health Insurance Fund(SHIF) and Medical Insurance companies in a Sh6.3 billion medical contract with the National Police Service (NPS).
Lawmakers seek to unravel the truth on claims of negligence as police officers who have been injured during the cause of duty have failed or delayed being compensated.
This is despite a contract signed between the NPS and the defunct National Health Insurance Fund (NHIF) with only 937 claims worth 709 million have been settled with 240 claims having worth 240 million have been rejected by Insurance companies.
National Police Service Commission NPSC chairperson Eliud Kinuthia decried that few policemen have been compensated with most claims being rejected or delayed in unclear circumstances.
Attempts to raise the issues with (NHIF) have hit a dead wall with the victims left to pay for their own medical service despite a binding agreement. So far a total of 1,966 police officers are claiming compensation after having various injuries while on duty.
“They are targeting a very vulnerable group that has no unions, NHIF can be arrogant to us and we will have nowhere to go, we are have been disadvantaged because we have no union and can’t make noise, so we suffer in silence,” he told senators.
Appearing before the Senate security defense and foreign relations Committee, Kinuthia disclosed that the National Police Service signed a contract with NHIF to compensate police officers that are injured on duty.
Since NHIF lacked the requisite capacity for medical treatment, it signed a different contract with private insurance companies to underwrite the claims.
Private insurance companies are now reneging on insurance contracts to compensate police officers who are injured on duty.
Currently,161 claims worth Sh.108 million are still being processed, 106 claims are awaiting proper documentation while 422 claims worth Sh444 million are still under internal review by NHIF now Social Heath Insurance SHA.
Social Health Insurance SHA Augustine Wafula, claims manager, said they are facing issues because of different terms of the contract signed between NPC and NHIF and the one signed between NHIF and the private companies.
“They are two contracts, one between NHIF and the police service and the one between NHIF and the co-insurers, some of the reasons that have been advanced for rejection is that an officer was assaulted when he was sleeping in his house, which they claim was not part of the contract,” Wafula noted.
“As the employer we don’t know those co- insurers, they are alien, we have no arrangements with them, but we are glad the one we entered a contract with has brought them, NHIF should take full responsibility of whoever they brought into the construal arrangement,” he added.
National Police Service Commission NPSC chairperson explained some of the issues raised by the private companies to void payments on the medical cases are ‘absurd’ calling for justice.
“They are telling us that the officer attacked in his house while sleeping and so he was not working, I want to say categorically that a police officer does not sleep, they just rest because we are on duty for 24 hours,” Kinuthia noted.
The chair of the committee William Cheptumo assured that through investigation will be conducted to ensure private companies are liable for medical payments for the injured police officers promising to ensure police officers injured on duty are fully compensated.
“The enemy here is SHIF or NHIF, they are the culprits, they can hide behind not being answerable to Insurance regulatory Authority, but I assure you, they will be answerable to us….. we will call all those co-insurer companies here to demand answers as to why they are not paying the claims,” Cheptumo said.
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