National Health Insurance Fund (NHIF) paid Meridian Medical Center yet it did not have the capacity to provide such services neither did it have branches in several places for which money was paid.
Solomon Parendo, the then NHIF Kericho branch manager, told trial magistrate Lawrence Mugambi that Meridian did not have a branch in Kericho when the scheme was rolled out.
“There were no facilities relating to Meridian medical at the time the NHIF scheme was rolled out,” Parendo testified.
The scheme, (civil servants and Disciplined services medical scheme) which was rolled out in January 2012 involved accrediting hospitals to cover out patient services, more so civil servants and Disciplined forces.
However, according to the defense, the capitated health provider could could cover a member via referral to another hospital.
“Treatment can be done in a different NHIF accredited hospital and the capitated institution will be invoiced to pay the money, not go back to claim at NHIF,” Parendo testified.
In the case, three former NHIF officials were charged alongside Meridian Medical Center directors with conspiracy to defraud NHIF Sh 116,935,500 by entering into a contract which Meridian was to provide medical services under the civil service and Disciplined services medical scheme knowing that the said hospital had no capacity to provide such services.
The accused persons include former NHIF Chief Executive, Richard Kerich, strategy and corporate planning manager Marwa Fadhili Chacha, assistant manager David Chingi, Meridian medical Directors Peter Ngunjiri Wambugu, Ndiba Wairioko and Meridian Medical Services.
Kerich and Chacha are further charged with willful failure to comply with laws relating to procurement by procuring the said Meridian medical as a service provider under the scheme.
The two, together with Chacha are charged with abuse of office by improperly conferring a benefit of Sh 43,498,125 to the said hospital.
Wambugu and Warioko and Meridian are charged with obtaining money by false pretences.
The three are said to have obtained the 43 million from NHIF by falsely pretending that Meridian had the capacity to provide medical services to civil servants and members of the disciplined forces throughout the country under the said scheme.
They all denied the charges.
The defense alluded that no complain was made by anyone that they were treated at Meridian and they failed to pay.
The defense also submitted that the contract does not specify the branches of Meridian Medical but it could refer patients.
Meridian was allegedly declared as a health provider to work with NHIF in 2009.
The court further heard that there was no provision/obligation in the contracts between health providers and NHIF to have clinics all over the country.
Patients complaints
Another witness, Vincent Magare was the NHIF quality assurance officer in Kakamega at the time, also testified that some patients complained that they were allocated health facilities they never chose including Meridian.
Magare stated that after receiving the the complains he directed them to the branch manager who ordered him to find out where Meridian is located.
“I came to know about Meridian after the complains since I was told to find out where it is located,” he said.
According to the officer, there was a signpost at the then Nakumatt building in Kakamega saying they were on first floor.
He told the court that he went there and found a lady who was examining a patient.
Magare testified that he tried to enquire from her about civil servants who visit their hospital but she told him to get in touch with the headquarter since she did not know such information.
The witness further told the court that he never inspected Meridian for accreditation during that time.
It was however, the defense statement that the scheme was treatment based and not branch based.
