A group of young doctors, pharmacists and hospital staff is suspected of running a well organised medical insurance fraud scheme that is bleeding the sector dry and giving investigators sleepless nights.
One arm of the cartel writes fake prescriptions for getting drugs from major hospitals using fake insurance cards then resells them to the market in what has taken fraud investigators more than one year to crack.
The other runs accurate data collection that involves identifying employers with lucrative outpatient and inpatient covers and whose employees rarely get admitted, produce identity documents and use them to admit other sick individuals in high end hospitals at a lesser fee.
The youthful doctors, some now working in government hospitals, come in handy to write accurate prescriptions that pharmacist would not doubt. They also know high net worth drugs complete with the targeted market.
They also have original prescription scripts from all the major hospitals, fake stamps as well as messengers who come in handy to either pose as the sick and collect the drugs to be delivered at a shop in downtown Nairobi at a fee. Where hospitals have put sophisticated systems, a pharmacist is recruited to help in taking out the original drugs.
The owners of the cards rarely realise the fraud unless they fall sick and find their covers exhausted, a rare occurrence since the fraudsters chose lucrative covers.
Manze I complained once hakuna siku we will do things the right way . People running successful business in kenya have balls made of steel and strengthened with titanium.
It’s having zero values. I have seen people brain storming on how to divert a % of funds meant for UNIMIX for malnourished kids. Eti “Lazima wakulie”. Just wonder where we went wrong.
Hii AON ya walimu ni big scandal. Wanaenda hospitali zingine wanafukuzwa eti their scheme doesn’t support. The private hospital charges them exorbitantly
I know of a couple which the wife was a medical insurance underwriter at the insurance firm and the husband a doctor who defrauded the company five million bob in related scams. But she was eventually fired. Waliamshwa kutoka pigsty yao 2 AM in the morning na kurushwa kwa cell.
I’ve seen places in this country where hospital stores in which this, ‘plumpy-nut’ and other nutritional commodities are kept are under the direct control of MCAs and other local politicians. Any health worker who protests is swiftly transferred elsewhere. Of course it’s no wonder that the commodities eventually find their way into the local shops. And, wonder of wonders, these are the same places where malnourished kids, expectant mothers, TB & HIV +ve patients need the products the most.
This country’s societal value is to steal as much as you can as long as your are in a position of power or responsibility. If you do your job with atmost honesty ppl view your as an idiot.