Nairobi Women’s bills scam probe extends to four related hospitals

Health facilities affiliated to owners of Nairobi Women’s Hospital will be investigated over inflated medical bills, a move likely to worsen the woes the management is currently experiencing.

Nairobi Women’s has recently been in the spotlight for inflating bills, a move that led many medical insurers to suspend the facility as an accredited service provider.

The hospital is now under the management of American private equity fund, Evercare, after its chief executive stepped aside.

The hospital was part of the Abraaj Growth Markets Health Fund (AGHF). Evercare took over the running of AGHF.

Evercare owns hospitals in Kenya, Pakistan and Nigeria.

In Kenya, Evercare has four other hospitals under its belt. These are the hospitals that are now under investigation by the Association of Kenya Insurers (AKI).

“The affiliated hospitals are grouped in Class 1. This is going to be our centre of focus. We believe that whatever is happening at Nairobi Women’s Hospital is a replica of what goes on in the other four hospitals,” revealed one of the directors at the AKI who sought anonymity as he is not allowed to speak to the media.

According to the director, after they are done with the Class 1 hospitals, they will move to other private facilities under Class 2.

“We are really going to put in place stringent measures. This is going to act as an example to other hospitals,” the director said.

Speaking separately, AKI chief executive Tom Gichuhi said the malpractice extends beyond Nairobi Women’s Hospital and that they are on the lookout to ensure everyone is brought to book.

He said AKI would involve the Kenya Health Federation to agree on how they are going to carry out business.

He said the high cost of drugs doctors prescribe had pushed the majority of medical cover providers into losses, putting the stability of the industry in jeopardy.

Increased demand for medical services and underfunding of the public hospitals are the key drivers of Kenya’s booming private healthcare sector.

“We want to agree on a way forward so that we provide a platform for all the players on the medical side.

“The hospital and doctors must make business sense. They should not be making profits while the insurers are making losses,” he said

Mr Gichuhi disclosed that they are in talks with Nairobi Women’s and that his team has drafted proposals that the hospital should address before the suspension is lifted.

“We will meet again and depending on the outcome of the meetings and if they are ready to adhere to proposals, that’s when we shall lift the suspension,” he said.

Mr Gichuhi added that all they want is to establish a good working relationship and ground rules, which will facilitate both sides to transact business.

The Nation ran an exposè a fortnight ago detailing the extent to which the management was going to maximise profit, sometimes making inpatients stay longer than necessary to accumulate more bills.

The messages showed that the revenue, commissions, admissions and discharge were being monitored hourly, every day and night by the CEO.

In multiple texts covering different days in 2018, a WhatsApp group resembled a trading floor, with Dr Wanjala and his chief operations officer Eunice Munyingi pushing employees to work harder and increase admissions.

Consequently, Jubilee, Britam, AAR, Old Mutual and CIC Group said they would no longer reimburse both inpatient and outpatient claims at any of the hospital’s branches.

The AKI said the suspension would remain in force pending a thorough review of the quality and cost of the hospital’s services, but that this would not affect insured customers already admitted.

The association added that it would engage service providers, through their associations, to address most – if not all – of the issues affecting the medical insurance business.