An explosive petition filed in the National Assembly on the grounds of public interest has now unearthed how a consortium of insurance firms and two other companies associated to a tycoon controlling vast interests in the medical field were on boarded as special purpose vehicles as capitator and medical scheme administrators respectively have controlled teachers’ medical cover for nine years at a cost of Sh161billion.
Besides being the perennial medical cover tender winners despite the contracts being floated for competitive bidding, the same firms have also separately been contracted to provide medical covers for the National Police Service (NPS) and Prisons Service officers.
The fresh details are emerging at a time teachers and police officers continue staring at a health crisis as hospitals started denying them services after their insurance provider failed to pay claims running into billions of shillings.
For the teachers cover, Minet Kenya Insurance Brokers Limited (MINET) is the lead consortium member and medical insurance provider has been contracted and paid by TSC Sh160billion for the last nine years.
The other underwriters for the insured benefit (consortium members) include Old Mutual General Insurance Kenya Limited, Britam General Insurance Company (Kenya) Limited, CIC General Insurance Limited and Star Discover Life Insurance Limited.
On the other hand, in the deal, according to petition filed in the National Assembly citing alleged irregular dealings and illegal administration of the teachers’ medical scheme, Bliss Healthcare Limited associated to Jayesh Saini and Medical Administrators Kenya Limited (MAKL) were on boarded as a master capitator and medical administrator respectively.
Jayesh’s has severally been named in Parliament and in a France court where he lost a defamation suit he filed against a Paris based Kenyan student Nelson Amenya in connection to the controversial Social Health Authority (SHA) Sh104billion system.
Besides teachers, police officers deployed to protect the Executive, the Legislature, Judiciary, Cabinet secretaries, principal secretaries, parastatal heads, security installations and Members of Parliament (MPs) are among thousands of those affected.
The National Treasury has a Sh29billion contract with Medical Administrative Kenya Limited (MAKL).
In the last financial year, the government allocated a premium of Sh17.9billion to the TSC as medical insurance cover for the over 400,000 tutors.
“The premiums as provided by the government are paid directly by the procuring entities (TSC) to Minet Kenya Limited. The funds are then channeled by the insurance companies to MAKL and Bliss for administration and capitation purposes. They then empanel hospitals and doctors that are then tied up as a network of hospitals to provide services for the teachers’ medical scheme. This means that the capitation manager has an agreement with hospitals under the network to provide cashless treatment to policyholders of the tenderers.” A petition dated March 5, 2024 signed by Amos Nyasani reads in part.
The petitioner implored upon the National Assembly to probe alleged “irregular dealings and illegal administration of the teachers’ medical insurance” by the above mentioned consortium of underwriters appointed by TSC including enforcing attendance of witnesses to examine them on oath, compel production of documents and issue a commission or request to examine witnesses abroad.
Reports indicate TSC), NPS and the Kenya Prisons Services (KPS) have not released capitation funds to both private and public hospitals for medical services offered to their employers.
In the last seven months, some of the contracted hospitals have not been paid their dues.
This has left more than 452,635 teachers and tutors without access to medical services in the country.
“The periodical non-payment of medical covers for teachers needs to stop. We want permanent solutions to end this. There should be constant remittance of money to TSC by the national government then TSC pays MINET who then pay their contracted administrators,” Kenya National Union of Teachers (KNUT) Secretary General Collins Oyuu noted.
Oyuu added that it is painful seeing his colleagues suffer for being turned away by hospitals because their health premiums have not been paid.
This is not the first time hospitals have started turning away patients from the affected groups requiring MAKL members pay in cash for all services.
In 2023, The Nairobi West Hospital (TNWH) threatened to discontinue medical provision to the members of the National Police Service (NPS) and Kenya Prison Services (KPS) over a demanded outstanding bill amounting to Sh576,785,334.
According to records seen by us, on September 30, 2023, the hospital raised a debt settlement demand amounting to Sh626,785,334.
On November 6, 2023, Nairobi West Hospital confirmed having received Sh50million.
Consequently, The Nairobi West Hospital (TNWH) threatened to discontinue the medical services scheme for police and prison officers over a Sh576,785,334 outstanding debts through a correspondence reference number FINB/MAKL/OS/14112023/NPS dated November 14, 2023.
In one of the correspondences, the hospital said that the debt has crippled the facility financially to the extent of being unable to pay doctors, service providers and suppliers “thus negatively impacting our procurement of medicine and other consumables.” Some of the documents reads in part.
Consequently, through a letter referenced Ref: NPS/IG/A/EST/7/40/VOL.IX/35 dated November 21, 2023, the office of the Inspector General of Police wrote to CIC General Insurance Ltd Chief Executive Officer (CEO) raising concerns over threats by Nairobi West Hospital to withdraw medical services scheme for police and prison officers over a Sh577million debt calling for intervention to forestall the crisis.
“The Nairobi West Hospital letter Ref:FIN/MAKL/OS/14112023/NPS dated November 14, 2023 refers. The Inspector General, National Police Service is in receipt of a copy of the above referred letter indicating their intention to suspend medical services offered to members of the National Police Service and Kenya Prisons Service. This is therefore to request for your intervention on the same to ensure that there is no interruption of services at the facility as intended. Kindly confirm action taken on the matter.” The correspondence signed by Rosemary Kurarau on behalf of the IGP read in part.
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