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Govt says biometrics used to aid and abet massive health insurance fraud in Kenya

Govt says biometrics used to aid and abet massive health insurance fraud in Kenya

A report recently released by Kenya’s Health Cabinet Secretary Susan Nakhumicha, has unveiled extensive fraud within the country’s National Health Insurance Fund (NHIF) scheme perpetrated partly by the use of biometrics.

According to the report, the fraud, which has cost the Kenyan government at least Sh20 billion (US$126.4 million) in losses, was carried out by several health facilities, some of which have now been asked to repay the money they are accused of making the government lose, Standard reports. About Sh171 million (US$1 million) has already been recovered.

Last year, the William Ruto administration replaced the NHIF with a new body dubbed the Social Health Authority (SHA), but the transition is facing legal challenges.

About 40 percent of hospitals accredited for the NHIF scheme are involved in the reported scam, and most of the payments are said to have been made to people claiming major surgeries which never were.

The outlet notes that the fraud is reported in the capital Nairobi and about 12 other counties.

In a press conference, Nakhumicha said some health facilities revived dormant insurance accounts, cooked up medical insurance claims and used fraudulent methods and biometrics collected from elsewhere to secure undeserved payments.

Some of the biometrics are reported to have been collected from students, under a now scrapped school health insurance scheme, with students coerced into submitting their personal details in exchange for food.

The biometrics collected from unsuspecting students were then used by some health facilities to initiate frivolous payment claims.

Kenya moved from a traditional method of identification to a biometric system for the country’s health insurance scheme in 2021.

The government report also finds that many of the health facilities involved in the scam do not have either the authorization or capacity to offer the services they claim were offered to those who received undue payments.

The Health Secretary is quoted as warning that all those involved in the scam in one way or the other will be severely punished after all the records and beneficiary data have been thoroughly audited. “The health ministry does not tolerate such unethical practices, eating into resources meant for providing affordable and quality treatment to citizens,” she said.

In a rebuttal, the Rural Private Hospitals Association of Kenya and the Kenya Medical Practitioners and Dentist Union have rejected the government’s claim, saying the allegations of Sh20 billion lost is a ploy to tarnish the image of the now defunct NHIF.

Biometrics can play great role in patient identification – Imprivata exec

In a related health development, Sean Kelly, chief medical officer and senior vice president of customer strategy for digital ID firm Imprivata, has emphasized the importance of biometrics in enhancing patient safety and managerial efficiency.

Kelly, in a piece published by Health Data Management holds that advancements in biometrics “offer a promising solution to improve patient identification accuracy,” and in 2024 and beyond, “facial biometrics will play a crucial role in reducing the risks of patient misidentification and improving the overall quality of care in healthcare organizations.”

She contends that while biometric modalities like face biometrics can play a great role in handling cases of patient misidentification, it also presents the challenge of privacy and security which must be given significant attention.

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