A brief by Minet Kenya, the firm contracted by TSC to manage the scheme, revealed more than 10 ways that teachers, their dependents and hospitals use to fleece the scheme.

They include impersonation, billing for services not rendered, billing for conditions not covered under the scheme, double billing of medical expenses and falsification of the length of stay of patients in hospitals.

Incorrect reporting of diagnosis or procedures, false and unnecessary prescription of drugs, abnormal utilisation of services, bribery and unethical inducement are also ways used to cheat.

Mutheu cited impersonation as one of the most unethical ways both teachers and medical facilities exploit the scheme.

“We are talking about public funds and we have a duty to care. We have a legal and investigations department dealing with these. As we speak, many cases are under investigation and dozen others in court,” said Muthui.

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He explained that in most cases, hospitals collude with teachers to abet impersonation.

“As we speak we have about six IVF patients who are not scheme members. This is an expensive treatment and we are presently carrying out investigations,” said Muthui.

He said male teachers have been caught taking members of their second family to benefit from the scheme against the laid down rules.

Muthui said in most cases, teachers use their identity to help their relatives such as parents, siblings, or unregistered spouses.

“In our African setup and tradition, your cousin may have a similar name as yours. Your niece or nephew may have the same name as your children. So they use the same name to get treatment from hospitals,” said Muthui.

“When the preauthorisation team comes, they find a totally different person from the listed beneficiary on the hospital bed.”

Impersonation is also done by teachers to cheat maternity cover. “In most cases, you find the person who is on the bed is not the one on the scheme roll,” said Muthui.

“For teachers who are caught in this malpractice we pass them over to TSC for the disciplinary procedure,” he added.

It also emerged that some hospitals make huge claims based on false diagnoses while others presented bills for members who were never admitted.

In other cases, the health facilities demand payment for patients not even treated.

“Other facilities also cheat on the number of days patients were admitted,” said Muthui.

Some hospitals also make claims on services not covered under the medical scheme. “They (hospitals) manufacture bills and forward them for payments,” said Muthui.

He said in the past, the scheme administrator has had cases where some hospitals made claims for gynaecological and maternity services offered for male members of the scheme.

Cases of bribery have also been reported among teachers and hospitals.

“We have had cases where hospitals bribed scheme members or members’ representatives to cover up false claims and other corrupt practices,” said Muthui.

“In one such case, a patient confirmed that no breast ultrasound or excision was carried out, yet the two services were included in the final bills.”

Teachers have yet another reason to be inspired as Rose Nyamunga, a nominated senator, has sworn not rest until teachers are freed from AON MINET or given improved health care by the latter. The Ruto allied senator empathized with teachers as she highlighted the frustrations teachers have experienced under the bogus health insurance provider. ‘Your employees are suffering seriously and you are seated watching. Rise from your comfort and give hope to the teachers,’ said rose Nyamunga to the Teachers Service Commission, TSC.

Senate Probe

Nyamunga’s plea forced the senate to open an investigation process, accusing AON MINET of acutely frustrating teachers in the name of offering health services.

The teachers service commission remitted ksh. 9B to AON MINET in the year 2020 and Ksh.12B this year, yet teachers receive low value health care under the service providers.

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Introduction of AON MINET as a health care service provider to teachers resulted to loss of medical allowance from teachers’ pay slips. The lowest paid teacher had a medical allowance of ksh. 3870 per month, an amount which unexpectedly shocked the entire senate.

Those set for interrogation by the Senate committee on Education include AON Minet management, TSC, and the Kenya National Union of Teachers (KNUT).Nyamunga questioned why teachers receive poor health services under AON MINET, that are not commensurate to the medical allowance that they lost. “How can teachers undergo double deductions on their pay slips both for National Hospital Insurance Fund (NHIF) and AON MINET yet there are no commensurate services?” Nyamunga questions AON management and TSC.

‘There is very low capitation on outpatient services with some teachers capped at as low as Sh900, which is inclusive of doctors’ consultations, tests and drugs. The teachers of this country are a frustrated lot and they feel their lives are potentially endangered by the poor services being offered under the AON MINET Kenya medical insurance cover,” says Nyamunga.

The Senate committee on education summoned KNUT Secretary-General Wilson Sossion to appear before it on 4^th November to respond to the allegations of Ms Nyamunga over gross mistreatment of teachers in the hands of AON MINET

Nyamunga insists that these concerns of below standard services by AON MINET are very serious and that TSC must fulfill the teachers’ need for quality healthcare.

“The decision to introduce a medical cover for teachers was very good because it was a step in the right direction. However, there appears to be glaring gaps and challenges that must be addressed by the employer immediately,” insists the furious Nyamunga.

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She quotes Article 43 (1) (a) of the Constitution which states,” Every person has a right to the highest attainable standard of health, which includes the right to healthcare services.”

Medical Allowance Back To Pay slips

If Nyamunga wins in her quest, then teachers will have medical allowance back to their pay slips, or TSC will contract a more competent health care provider to serve teachers.