SHIF 99pc digitized to combat fraud, says Nakhumicha

Health Cabinet Secretary Susan Nakhumicha has revealed that the Social Health Insurance Fund (SHIF) is now 99 per cent digitized as the country transitions from the National Health Insurance Fund (NHIF).

The CS said the move will ensure verifiable data capture to prevent issues such as double billing and fraudulent claims which were rampant under NHIF.

“Typing errors are things that can easily be taken care of, and that is why SHIF is 99% digitized,” stated Nakhumicha.

Nakhumicha clarified that no private insurance company has been outsourced for claims management.

She said SHIF will utilize a claims management system owned by the State Health Authority (SHA) to ensure that the management of claims remains under government oversight.

Nakhumicha acknowledged the numerous loopholes that plagued the NHIF system over its existence in the last 50 years, saying the government has undertaken an audit to verify the services provided by each facility.

“We must use the existing institutions to ensure a proper audit of facilities is done for them to be enrolled to Social Health Insurance as a service provider. For example, we have heard cases where a facility claimed to have done surgeries yet they do not have a theatre, that is fraud,” she said.

The CS said the new health model will now offer up to Ksh11,200 for normal deliveries and Ksh32,200 shillings for caesarian deliveries, which is higher than the previous NHIF reimbursements of Ksh5,000 and Ksh17,000, respectively.

Nakhumicha assured that the government will pay premiums for individuals who are unable to generate income, including people living with disabilities and the elderly.

To ensure a smooth transition to SHIF, the CS said a suitability test will be conducted for NHIF staff to assess their expertise and experience.

“We need to have the right people doing the right job. We are going to have a suitability test of the staff within NHIF as we transit them to see whether they have the expertise and experience to run the system.”