A fresh probe has unearthed systemic loopholes that aided the siphoning of billions of public funds from the National Health Insurance Fund (NHIF).

A report, by the Ethics and Anti-Corruption Commission exposes loopholes and avenues that were used to steal the billions from the insurer.

In the two-month survey conducted between August 31 to November 2, 2023, it was established that there were numerous infiltration of the digital claims system by third parties, through which funds were pilfered.

While reviewing system audit logs, the investigations revealed that numerous third-party unauthorized access to enterprise systems led to the addition of unauthorized services to Health Care Providers (HCPs).

Without giving comprehensive figures of the funds that were stolen, the investigation sampled NHIF regional and branch offices in Nakuru, Embu and Mombasa where 12 specialised services were added to one HCP.

“Privileged transactions were carried out by unauthorized users in the E-Claims system,” Dr David Oginde, the EACC chairperson said when he released the report yesterday.

And this happened with the knowledge of some NHIF staff who colluded with managers in the various health care providers involved. 

The investigation picked glaring anomalies where an amendment to members’ and health care providers data and processing of transactions without approval workflows, was picked.

“Three staff irregularly amended member details occasioning a loss of Sh29,958,642 to the Fund,” said Oginde who was flanked by Medical Services Principal secretary Harry Kimtai, Social Health Authority chairman Timothy Olweny and Chief Executive Officer Elijah Wachira as well as NHIF Board Chair Eng Michael Kamau.

The report also found out that assignment and withdrawal of ‘First In, First Out- FIFO’ override rights, adding and removing of service codes to HCP facilities, aiding disappearance of funds. 

“There was also arbitrary assignment of FIFO override rights, enabling unauthorised personnel to process claims without the FIFO principle,” added Dr Oginde, pointing out that the review noted that failure to promptly migrate users’ system profiles for transferred staff, also aided theft.