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{
"id": 1401001,
"url": "http://info.mzalendo.com/api/v0.1/hansard/entries/1401001/?format=api",
"text_counter": 162,
"type": "speech",
"speaker_name": "Sen. (Prof.) Tom Odhiambo Ojienda, SC",
"speaker_title": "",
"speaker": null,
"content": "Mr. Deputy Speaker, Sir, Question No.009 that goes to the Cabinet Secretary for Health is framed in three parts. (a) Could the Cabinet Secretary for Health confirm that there is widespread medical insurance fraud perpetrated by healthcare facilities in Kenya, particularly within the private health sector, through practices such as unnecessary medical tests, scans and incorrect diagnosis, aimed at unfairly generating revenue for the facilities? (b) Has the Government conducted an inquiry into this matter, and if so, could the Cabinet Secretary table the report of its findings? (c) What measures has the Government put in place to ensure accountability by healthcare facilities and to provide compensation to the victims of medical insurance fraud? I thank you."
},
{
"id": 1401002,
"url": "http://info.mzalendo.com/api/v0.1/hansard/entries/1401002/?format=api",
"text_counter": 163,
"type": "speech",
"speaker_name": "Sen. Kathuri",
"speaker_title": "The Deputy Speaker",
"speaker": {
"id": 13590,
"legal_name": "Murungi Kathuri",
"slug": "murungi-kathuri"
},
"content": " Madam Cabinet Secretary, kindly answer the questions."
},
{
"id": 1401003,
"url": "http://info.mzalendo.com/api/v0.1/hansard/entries/1401003/?format=api",
"text_counter": 164,
"type": "speech",
"speaker_name": "Hon. Nakhumicha",
"speaker_title": "The Cabinet Secretary for Health",
"speaker": {
"id": 520,
"legal_name": "Reginalda Nakhumicha Wanyonyi",
"slug": "reginalda-nakhumicha-wanyonyi"
},
"content": " Thank you, Mr. Deputy Speaker, Sir and Hon. Senators. It is always a pleasure to come to the Senate and apprise The electronic version of the Senate Hansard Report is for information purposesonly. A certified version of this Report can be obtained from the Director, Hansard and AudioServices, Senate."
},
{
"id": 1401004,
"url": "http://info.mzalendo.com/api/v0.1/hansard/entries/1401004/?format=api",
"text_counter": 165,
"type": "speech",
"speaker_name": "Hon. Nakhumicha",
"speaker_title": "The Cabinet Secretary for Health",
"speaker": {
"id": 520,
"legal_name": "Reginalda Nakhumicha Wanyonyi",
"slug": "reginalda-nakhumicha-wanyonyi"
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"content": "Senators on matters in the Ministry of Health. I am happy to respond to this Question raised by the Senator for Kisumu, Prof. Ojienda. I also request that after I respond to the questions by Sen. (Prof.) Ojienda, please allow me to also apprise the House on the ongoing crisis we have at the Ministry of Health (MoH)."
},
{
"id": 1401005,
"url": "http://info.mzalendo.com/api/v0.1/hansard/entries/1401005/?format=api",
"text_counter": 166,
"type": "scene",
"speaker_name": "",
"speaker_title": "",
"speaker": null,
"content": "(Applause)"
},
{
"id": 1401006,
"url": "http://info.mzalendo.com/api/v0.1/hansard/entries/1401006/?format=api",
"text_counter": 167,
"type": "speech",
"speaker_name": "Sen. Kathuri",
"speaker_title": "The Deputy Speaker",
"speaker": {
"id": 13590,
"legal_name": "Murungi Kathuri",
"slug": "murungi-kathuri"
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"content": " Hon. Cabinet Secretary, I give guidance that you first answer the Question and then I will give you an opportunity under Standing Order No.51 (c) to give that statement. We will first dispense off the Question by Sen. (Prof.) Ojienda, avoiding the matter of the strike and then after her statement, I will open the Floor to Senators to ask a few questions on that matter. Proceed, Madam Cabinet Secretary."
},
{
"id": 1401007,
"url": "http://info.mzalendo.com/api/v0.1/hansard/entries/1401007/?format=api",
"text_counter": 168,
"type": "speech",
"speaker_name": "Hon. Nakhumicha",
"speaker_title": "The Cabinet Secretary for Health",
"speaker": {
"id": 520,
"legal_name": "Reginalda Nakhumicha Wanyonyi",
"slug": "reginalda-nakhumicha-wanyonyi"
},
"content": " Thank you, Mr. Deputy Speaker, Sir, and Members. The question was that I confirm that there is widespread medical insurance fraud that is perpetuated by health facilities in Kenya, particularly within the private health sector, through practices such as unnecessary medical tests, scans and incorrect diagnoses aimed at unfairly generating revenue for facilities. The issue of medical insurance fraud committed by health facilities in Kenya, including the private sector, is a serious concern that has received attention from the Ministry of Health regulatory authorities and enforcement agencies. There have been reported cases of facilities engaging in fraudulent practices to unfairly generate revenue, such as impersonations, raising fake claims for patients who never received any service, ordering unnecessary tests or procedures, providing incorrect diagnoses and inflating bills submitted to insurance providers. These fraudulent activities not only harm patients by subjecting them to unnecessary medical interventions, but also lead to financial losses for insurance companies and undermine the integrity of the healthcare systems. Consequently, the MoH, the National Health Insurance Fund (NHIF) and the Kenya Medical Practitioners and Dentists Council (KMPDC) have taken action to address these issues, including suspending facilities found guilty of engaging in fraudulent practices. Mr. Deputy Speaker, Sir, currently, the prevalence of medical fraud as per external actuarial analysis stands at 20 per cent. It is important for stakeholders, including insurance providers, regulatory bodies, investigative bodies and law enforcement agencies to collaborate and identify investigating and prosecuting individuals and facilities involved in insurance fraud. By enforcing strict regulations, conducting thorough audits and promoting transparency and accountability in health care delivery, we can collectively work towards combating fraudulent activities and safeguarding the interests of patients and insurance beneficiaries. The electronic version of the Senate Hansard Report is for information purposesonly. A certified version of this Report can be obtained from the Director, Hansard and AudioServices, Senate."
},
{
"id": 1401008,
"url": "http://info.mzalendo.com/api/v0.1/hansard/entries/1401008/?format=api",
"text_counter": 169,
"type": "speech",
"speaker_name": "Hon. Nakhumicha",
"speaker_title": "The Cabinet Secretary for Health",
"speaker": {
"id": 520,
"legal_name": "Reginalda Nakhumicha Wanyonyi",
"slug": "reginalda-nakhumicha-wanyonyi"
},
"content": "The second question on whether the Government has conducted an inquiry into this matter, and if so, if the Cabinet Secretary could table the report of its findings, I wish to respond as follows: I confirm that the MoH, NHIF and KMPDC have been actively addressing cases of medical fraud within the healthcare sector. Through joint efforts and investigations, several facilities have been identified and subsequently, suspended for engaging in fraudulent activities that compromise patient care and violate ethical standards. I would like to note that authorities have taken steps to investigate and address instances of medical insurance fraud. Efforts have been made to scrutinize the practices of healthcare facilities, assess compliance with regulations, and hold to account those found to be involved in fraudulent schemes that are detrimental to both patients and insurance providers. There are ongoing investigations by the Ethics and Anti-Corruption Commission (EACC) and the Directorate of Criminal Investigations (DCI) involving 10 healthcare providers currently suspended by the NHIF Board. Mr. Deputy Speaker, Sir, I have annexed the list in my response. We collectively strive to uphold the integrity of the healthcare systems and protect the welfare of patients and insurance beneficiaries. I encourage continued collaboration among stakeholders, effective enforcement of regulations and clear communication to promote trust and accountability in healthcare delivery. The third question is on the measures the Government has put in place to ensure accountability by healthcare facilities and to provide compensation to the victims of medical insurance fraud. The Government of Kenya has implemented and is working on various measures to enhance accountability and combat medical fraud within healthcare facilities. One of the efforts that the Government has put in place is the health facilities census and we did this last year in August. The Government conducted a comprehensive census of health facilities to create a database that facilitates the monitoring and regulation of healthcare facilities. This initiative aims to identify and verify facilities to ensure compliance with standards and detect any unauthorized fraudulent practices. The second measure we have taken is the repealing of the NHIF Act, of 1998. The decision to repeal this Act and enactment of the Social Health Insurance Act of 2023 is a strategic move by the Government to strengthen regulatory frameworks and enhance oversight mechanisms within the healthcare sector. By enhancing the Social Health Insurance Act, the Government will introduce updated provisions that safeguard against fraudulent activities, improve transparency and enforce accountability measures for healthcare facilities and providers. I thank you, Mr. Deputy Speaker, Sir, and Senators, because this House participated in the enactment of those laws during the process. The Ministry appreciates the Senate for the effort they put in. We are in the process of procuring a smart digital system. The Government is in the process of acquiring this system designed to combat fraud activities. This signifies a proactive approach to addressing malpractices in healthcare delivery. The sophisticated digital system will streamline data management, facilitate real-time monitoring of healthcare transactions and employ advanced analytics to detect anomalies or The electronic version of the Senate Hansard Report is for information purposesonly. A certified version of this Report can be obtained from the Director, Hansard and AudioServices, Senate."
},
{
"id": 1401009,
"url": "http://info.mzalendo.com/api/v0.1/hansard/entries/1401009/?format=api",
"text_counter": 170,
"type": "speech",
"speaker_name": "Hon. Nakhumicha",
"speaker_title": "The Cabinet Secretary for Health",
"speaker": {
"id": 520,
"legal_name": "Reginalda Nakhumicha Wanyonyi",
"slug": "reginalda-nakhumicha-wanyonyi"
},
"content": "irregularities that may indicate fraudulent behaviour. The system will be integrated with approved clinical guidelines to ensure patient management is standardised. The fourth one, Mr. Deputy Speaker, Sir, is enhanced monitoring and enforcement. The Government has intensified efforts to monitor healthcare facilities and enforce compliance with regulations. Enhancement of oversight through frequent inspections, audits and performance of evaluations is going to enable regulatory bodies and the Social Health Authority to hold facilities accountable for adherence to ethical standards, quality care and financial transparency, thereby reducing the likelihood of fraudulent activities. The fifth one is on creating public awareness and reporting mechanisms. The Government is also focused on raising public awareness about medical fraud and encouraging individuals to report any suspicious experiences of fraudulent practices in healthcare facilities. This will be done by promoting transparency, accountability and whistle-blower protection. The Government will empower the public to play an active role in combating fraud and ensuring accountability within the health sector. Mr. Deputy Speaker, Sir, regarding the compensation of victims of medical fraud, the MoH and its agencies are not expected to compensate any victim of medical insurance fraud. However, the Insurance Regulatory Authority (IRA) may provide more details if there have been compensations to victims of medical insurance fraud. Mr. Deputy Speaker, Sir, and Hon. Members, I submit. Thank you."
},
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"id": 1401010,
"url": "http://info.mzalendo.com/api/v0.1/hansard/entries/1401010/?format=api",
"text_counter": 171,
"type": "speech",
"speaker_name": "Sen. Kathuri",
"speaker_title": "The Deputy Speaker",
"speaker": {
"id": 13590,
"legal_name": "Murungi Kathuri",
"slug": "murungi-kathuri"
},
"content": " Thank you, Hon. Cabinet Secretary. Sen. (Prof.) Ojienda, do you have any supplementary questions? You have an opportunity to ask two. However, if you do not have and are satisfied, it is good enough."
}
]
}