NHIF Scam: Judge Declines To Order Reopening Of Joy Nursing Home

By The Weekly Vision Reporter

Judge Jirus Ngaah of the Nairobi High Court has declined to grant a request for the reopening of Joy Nursing Home and Maternity in Nairobi’s Eastleigh Estate. In a submission dated June 26, 2023, an application was made by Joy Nursing Home and Maternity to contest the decision by the National Hospital Health Insurance Fund Board.

The decision entailed the shutdown of the Health Insurance Claim System and the temporary suspension of the applicant’s participation in it. In addition, the applicant sought legal remedies to instruct the NHIF Board to enable the Health Insurance Claim System and to rescind the suspension of the applicant’s operations, thereby allowing them to proceed with their business activities without interruption.

Joy Nursing Home administrator Kennedy Otieno. Courtesy

The application was based on a statutory statement dated June 26, 2023, and an affidavit sworn on that date by Kennedy Otieno Tindi. According to these documents, on or about July 20, 2022, the applicant and the National Hospital Health Insurance Fund Board entered into a written contract in which the applicant agreed to provide healthcare services to the beneficiaries of the NHIF Board. The latter was to pay the applicant for the health care services provided to its beneficiaries.

On June 18, 2023, NTV broadcasted a report claiming that some healthcare facilities, including Joy Nursing Home and Maternity, are deceiving vulnerable Kenyans, misappropriating public funds, and offering what the applicant has labelled as “harmful healthcare services to patients.” In light of the disclosure, on June 19, 2023, the Cabinet Secretary for the Ministry of Health directed the National Hospital Health Insurance Fund Board, through an official statement, to suspend the operations of the health facilities mentioned in the NTV expose`. 

Joy Nursing Home and Maternity were informed on the same material date that their license to operate as a healthcare provider had been suspended. The facility received a letter dated June 19, 2023, conveying this information. Subsequently, the NHIF Board took action to shut down their health insurance claim system. Additionally, the first respondent issued a press statement recommending their beneficiaries seek health services from alternative healthcare providers instead of Joy Nursing Home and Maternity.

Nonetheless, the hospital asserted that it had not been allowed to defend itself and respond to the accusations made against it before its services were suspended.  Dr. Samson Kuhora swore a replying affidavit on behalf of the National Hospital Health Insurance Fund Board and stated that he was the acting Chief Executive Officer of the National Hospital Health Insurance Fund Board.

He admitted that he is aware that on June 18, 2023, NTV aired an expose’ that shed light on healthcare facilities involved in scamming vulnerable Kenyans, misusing public resources, and providing injurious healthcare services to patients. As far as the applicant is concerned, the expose’ highlighted that the Joy Nursing Home and maternity facility took advantage of the elderly and vulnerable citizens in need of medical attention to fraudulently claim reimbursement from the NHIF for procedures and services not offered.

The expose’ further highlighted that Joy Nursing Home and maternity facility received payments in the sum of over Ksh. 225,000,000 as payment for medical services and procedures allegedly offered to the beneficiaries of the National Hospital Health Insurance Fund Board between July 2022 and June 2023.

In his judgement, the judge noted, “As noted earlier, the relationship between the applicant and the first respondent was governed by terms of a contract executed between them. If the first respondent breached the contract or any of its terms, that breach cannot be termed an illegality.”.

The final orders read, “For the reasons I have given, I am not satisfied that the applicant’s application has any merits. It is, in fact, an abuse of the process of this Honourable Court. It is dismissed with costs to the respondents. It is so ordered.”.