NHIF is at it again, this time with the 22 billion Karen Hospital scandal and the Meridian Saga at the Anti-corruption court. The current CEO accused that he has no previous experience or academic qualifications is now working vigorously to retain his job. The new Cabinet Secretary having promised a cleanup at NHIF is having an uphill task to prove he can indeed run a public office.
According to sources, officers at NHIF have since been cleverly sharing the 4.3 billion Civil Servant Scheme between themselves and medical providers who came in to replace Clinix and Meridian. Now with an angered Meridian filing a strong suite in court, likely to cost NHIF senior managers their jobs, heinous but tactical strategies are put to place by NHIF's CEO and legal advisor.
The 4.3 Billion CivIl Servant Scandal Fully Exposed in detail
The 4.3 billion Civil Servant Scheme was a move by the Ministry of Public Service, which initially decided to approach insurance firms to offer comprehensive health services to civil servants as opposed to the previous system where medical compensation was included into civil servants salaries. The scheme would give civil servants more comprehensive services including provision for family members.
Insurance firms bid for the scheme, with most bids ranging from 7 billion shillings to 12 billion shillings. These bids were not responsive because the Ministry of Public Service had only 4.3 billion to spare. Left with no choice, the Ministry approached NHIF which had 150,000 civil servants covered under their scheme B and C. In total the civil servants are 220,000 and together with their families they came to approximately 900,000.
NHIF had just carried out a pilot study on a new system called capitation, where medical service providers would be paid beforehand to offer services to a given number of people. This system meant NHIF would minimize all their risk, which instead would be bared by the medical service providers.
Seeing the opportunity to launch the capitation system, NHIF decided to offer medical service providers a payment of Sh2,850/= per person per year for unlimited outpatient services to the Civil Service Scheme, including specialists, radiological examinations, laboratory tests, drugs, treatment of chronic conditions, and even family planning.
Many clinics and hospitals refused the figure of Sh2,850 claiming it was too low for comprehensive services. Over 300 public medical service providers were included and a few private providers that included Clinix, Meridian and Thika Nursing. The three had participated in the pilot project. These clinics took the opportunity to enlist having already tested the system and seeing that even at Sh 2,850 per person, the scheme could still be feasible, while other medical service providers were uncommitted seeing it as too risky and unprofitable.
The award of the scheme by the Ministry of Public Services to NHIF angered many. The insurance firms were furious having lost their bids of up to 12 billion to the NHIF capitation scheme. Also angered were the other medical service providers who had initially refused to enlist into the project, only for it to turn out as a huge success.
A vendetta against NHIF was now being put to action as the different groups (insurance firms and disgruntled medical service) tried to punch holes into the successful scheme. The targets were the two main private medical service providers in the scheme, Meridian and Clinix.
Given the slow licensing procedure of clinics and hospitals by the Kenya Medical, Practitioners and Dentist Board, it was obvious that some of the many operating clinics registered by Meridian and Clinix were still awaiting their licenses to be released. The groups against the scheme used this inefficiency to create the Ghost Clinic Scandal.
The negative publicity that hit NHIF from then brought in many cartels eyeing the 4.3 billion shillings scheme. This resulted in a split of the Management and Board at NHIF. The Board on one hand trying to replace the CEO and the Management on the other fighting succession battles and control of the 4.3 billion shillings scheme. With everyone trying to get a piece of the pie, a struggle emerged at NHIF. The CEO was sacked as the two service providers Meridian and Clinix lost more than they had bargained for, as their contracts were terminated, . The 4.3 billion shilling scheme however still remained at NHIF.
The cartels of medical service providers and split management at NHIF picked their own medical service providers to replace Clinix and Meridian. This was difficult because the two had a large network and over 200 new medical service providers had now to be enlisted. This included non-existent facilities that are currently being used to siphon out part of the 4.3 billion. In Nairobi Acacia Medical Centre, Afya Royal and Nairobi Outpatient were used in the replacement process. Agha Khan and Karen Hospital came in but on a fee for service scheme that proved to be very expensive.
A parliamentary committee was assigned to investigate into the purported ‘ghost clinic’ scandal. Their report indicated no wrong doings but recommended more investigations into the late registration of clinics by the Director of Medical Services.
The Efficiency Monitoring Unit conducted a thorough investigation giving Meridian and Clinix a clean bill of health however indicating a level of incompetence in the Legal Services and the Benefits Departments at NHIF.
The Kenya National Audit also carried out their investigations and warned NHIF of serious losses if they refused to pay the two clinics. The same was noted by the Attorney General, who noted that the fund would suffer dire consequences from the cancellation of the contracts of Meridian and Clinix.
In September 2013 Meridian filed a suit claiming in excess of 800 million shillings from NHIF. This created panic at the fund, which quickly sought legal advice on possible ways to deal with the case.
According to sources from the current NHIF Management, the Legal Officer and Managing Director approached the EACC to coerce them to create a criminal case against Meridian, as that was the only way to hinder the civil suit of 800 million shillings, and protect their jobs. They actively forced employees to sign witness documents to sacrifice some of the junior officers and incriminate the former CEO for abuse of office. A lot of money was spent at EACC and also in the media.
The level of corruption in the Kenya Public Sector is so high that it will take decades to completly eliminate. The Cabinet Secretary of the Ministry of Health promised to overhaul the whole of NHIF but has found himself caught up in the mix of scandals. Unless he makes radical decisions he will also be implicated in the ongoing scandals such as the current utilization of the 4.3 billion Civil Servants Scheme, which is currently being dished out to some nonexistent providers. The 22 billion Karen hospital scandal might also end up eating more of the tax payers money. It is more than clear that NHIF requires major reforms and unless the public takes a stand, gorvernment officials will continue to abuse office and misuse the media to feed the nation lies and bullsh**.
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