An audit of a medical scheme for public officers has raised questions over Sh2.62 billion in claims, after the Auditor-General found that the records meant to back the payments were missing basic details.
In her report for the year ended June 30, 2025, Auditor-General Nancy Gathungu said the fund did not provide enough documents for her to verify the spending, which she said raises concerns about accountability in running the scheme.
The records supporting the Sh2.62 billion did not identify patients by name or Social Health Authority (SHA) membership number. They also lacked the patients' employers, the medical procedures carried out, and the amounts claimed and approved.
The auditor also found no details of the hospitals where treatment was given, the dates of admission and discharge, or information on patients treated abroad.
Without this information, Gathungu said she could not establish the accuracy and completeness of the benefits expenditure. The gaps also meant the claims could not be checked independently against the patients treated, the services provided and the amounts approved for payment.
The report does not say the whole amount was fraudulent or stolen. It says the missing records prevent independent confirmation that the money was properly spent.
The fund reported Sh6.34 billion in benefits expenses for the year. This comprised Sh2.62 billion in scheme benefits, Sh322.42 million in incurred-but-not-claimed liabilities and Sh3.40 billion in outstanding claim reserves.
The auditor said she could not verify two other figures. One was Sh5.27 billion that the fund reported was owed to it, because management did not provide the records needed to support the figure. The other was Sh1.79 billion in bills and other payments the fund reported it owed. In that case, management did not provide the supporting schedules, ledgers and calculations to show whether the amounts were correct.
Gathungu also questioned Sh994.4 million recorded as expenditure on May 28, 2025. The payment appears in the cash book as a "bank file" and as a contra entry in the bank statement.
Management did not provide the expenditure ledger showing where the payment was charged. The supporting schedule also lacked the employment numbers of the public officers treated and the dates of service.
"The accuracy and completeness of the expenditure amounting to Sh994,409,819 could not be confirmed," Gathungu said.
Reader Discussion (0)
Sign in to comment