TSC Medical Cover Administrators Suspends Nairobi Women’s Hospital Health Services
The Teachers Service Commission (TSC) Medical Cover Administrators have suspended the Inpatient Health Services of Nairobi Women’s Hospital following allegations of fraudulent activities in the facility.
A letter dated 25th of April 2020 and titled, “Suspension of Inpatient Healthcare Services-Teachers Service Commission Medical Scheme 2013-2020,” was sent to the hospital notifying it of breach of contract.
In the letter, TSC’s Medical Cover Administrators claim that the hospital is engaged in contract malpractice and fraudulent activities.
In specific terms, the administrators claimed that Nairobi Women’s Hospital was charging money from members, conducting unjustified tests, and the member patients were not in the ward as reported during audit visits.
“These identified issues by your Facility amounts to a breach of warranty and the following contractual Provisions,” indicated the letter while listing the contractual provision breached.
“…your Healthcare Facility (Nairobi Women’s Hospital) is hereby SUSPENDED from providing INPATIENT HEALTHCARE SERVICES to TSC Scheme Members with EFFECT 28™ April 2020 until all investigations are concluded,” read the letter.
“Please stand advised that, upon receipt of this letter, you are NOT PERMITTED to offer the said healthcare services to the Scheme Members until further notice,” cautioned the Medical Administrators.
“Any exercise of rights or remedies by Medical Administrators Kenya Limited to recover all of its monies under the Agreement shall not limit or affect any other rights or remedies available to it under Kenyan Law,” ended the letter.
According to the contract agreement between the Medical facility and the Teachers employer, TSC’s Medical Administrators Kenya Limited is empowered on behalf of the teachers’ commission to investigate facts giving rise to fraud, abuse or waste. As that happens, the Administrators may suspend the facility’s health service provision to the TSC employees pending the outcome of the investigation.
Below is the image of the letter sent to Nairobi Women’s Hospital from TSC Medical Cover Administrators.
In early February 2020, Kenya Revenue Authority (KRA) and all the medical insurers including Jubilee, Britam, UAP, AAR, APA, CIC, and GA Insurance, suspended Nairobi Women’s Hospital from their list of accredited service providers. This is after it was claimed that the facility was inflating bills by admitting non-deserving cases among others.
However, the hospital’s Chief Executive Officer Felix Wanjala dismissed the claims before stepping aside to allow for investigations.
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