The Kenya Union of Post Primary Education Teachers (KUPPET) Bomet branch vice chairman has warned members against what he describes as a fraudulent scheme by some private medical practitioners.
According to Kibet Samoei, certain health facilities have been capping Social Health Authority (SHA) outpatient cover to as low as Sh1,000, exposing members to unwarranted financial exploitation.
In an advisory issued to teachers, Samoei said the scheme was a coordinated attempt by cartels to fleece public servants.
"This is an orchestrated scheme by cartels to extort unsuspecting clients by demanding direct out-of-pocket payments from patients. The culprits then proceed to claim refunds for those exact services from the national insurance provider," Samoei said.
He said the unauthorised caps undermine the objective of public health insurance reforms, which seek to ease the medical burden on workers and their families.
By making members pay cash for services that should otherwise be covered under their health schemes, he said, the practitioners are double-dipping, taking cash from patients while also filing reimbursement claims with the insurer.
Samoei urged teachers and public workers across the region to remain vigilant, verify medical charges and report any health facilities attempting to impose arbitrary restrictions on their insurance benefits.
"We endeavour to thwart any attempt to defraud our membership. We call upon our colleagues to exercise caution and avoid falling prey to such predatory practices," he said.
He also called on regulatory bodies and law enforcement agencies to crack down on health facilities exploiting public health frameworks for illicit financial gain.
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