Teachers Insurance broker suspends and terminates contracts for health providers

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Eight facilities serving tutors have been terminated, four suspended, while three for the security agents have been cancelled.

In its scheme report released this month, AoN Insurance says it has also forwarded a number of cases to the Insurance Regulatory Authority (IRA) for investigation.

“In the case of client-initiated fraud, the matter has been taken up with the employer,” says the report.

The reasons for terminations were claims on patients who were never treated, double billing on procedures undertaken by National Hospital Insurance Fund (NHIF), preauthorisation on clients not admitted, and conversion of primary diseases to chronic illness and treatment mismatch.

The four facilities whose services were suspended were involved in advertisement of services. “Facilities whose services have been suspended include: Neno Opticians, Sigmart Optical Centre, Crystal Optics both in Kiambu County and International Optica in Mombasa,” states the report.

Those whose contract had been terminated are Mwea  County Medical Centre in Kirinyaga, Meswo Medical Clinic (Nandi), Mother Solbritt Nursing Home (Kuria East), Griftu Nursing Home (Wajir), Mashallah Nursing Home (Wajir), ISMC Clinic and Hospital (Marsabit), Kerugoya Medical Centre (Kirinyaga) and Sofiaz Medical Clinics (Taita Taveta).

Last year, AoN Insurance deputy managing director Sammy Muthui said severing links with companies that were involved in fraud had saved the institution over Sh50 million.

During the period a total of 16 service providers were kicked out due to cheating.

The insurance broker won the deal to provide medical cover to over 305,000 teachers at Sh5.6 billion per year. It also serves more than 107,000 police officers and prison warders.

Recent data from IRA show that cases of medical insurance fraud are on the rise.

Last year, the IRA report revealed that Sh366.9 million was involved compared to Sh102.76 million in 2015.

courtesy of business daily