EACC Exposes How Millions of EduAfya Scheme Were Stolen
An expose has been published by the Ethics and Anti-Corruption Commission (EACC) detailing the misappropriation of funds from the EduAfya Scheme by government officials.
The findings of an investigation into the National Hospital Insurance Fund’s (NHIF) systems, policies, procedures, and work practices were disclosed by the anti-corruption agency.
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Edu Afya, a comprehensive medical insurance cover for students enrolled in all public secondary institutions, was introduced in May 2018 by the Ministry of Education in collaboration with the NHIF.
The program was applicable to every student enrolled in public secondary institutions in Kenya. The government remitted a premium payment of Sh1,350 per pupil via the cover.
EACC stated in the report that certain Health Care Professions (HCPs) arranged transportation to pick up students from their schools in order to satisfy induced demand.
Additionally, some HCPs conducted school outreach activities that spurred demand. Some private HCPs failed to provide students with records such as invoices for rendered services.
“This creates avenues for falsified claims,” the document noted. The government allocated Sh9.5 billion to the NHIF over four years, from 2019 to 2022, as part of the EduAfya program.
Outpatient and inpatient services, day surgical services, a local road ambulance, and emergency air rescue services were all included in the program.
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The list of beneficiaries submitted to the Ministry of Education included information for both capitated and fixed fees for services (FFS) beneficiaries, according to the report.
The report claimed that the list provided an inaccurate representation of the results obtained from the scheme and suggested that the data was compromised or inaccurate.
The report cited an Edu-Afya report of 701 beneficiaries generated for HCP code 7779124, which revealed 184 FFS beneficiaries with a claim totaling Sh175,300.
Additionally, it referenced an Edu-Afya report that was produced for HCP code 77798602, which included 12 beneficiaries ranging in age from 26 to 57 years.
Moreover, certain students were found to be lacking of Unified Personal Identification (UPI) numbers, according to the report.
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This situation posed a challenge in terms of benefit accessibility, resulting in their parents having to bear personal financial obligations.
The report also documented cases in which certain EduAfya members engaged in double registration.
In addition, the document disclosed that concurrent outpatient and rebate claims were processed and paid for some EduAfya beneficiaries who were also National Health Insurance Scheme dependents.
In some instances, a student would visit a facility more than ten times per month, according to EACC.
The commission stated that the weaknesses observed indicate weak controls in the registration of beneficiaries and administration of the Edu Afya Scheme, resulting in the loss and misappropriation of funds.
EACC suggested that errant HCPs be sanctioned and that Edu-Afya data be cleansed in order to improve data integrity and reporting precision.
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Additionally, it was suggested that the Ministry of Education take measures to ensure that Unified Personal Identification numbers are issued to all students.
EACC Exposes How Millions of EduAfya Scheme Were Stolen
