NEWS SERVICE REPORTS
FROM THE AFRICAN
launch will curb
medical insurance fraud
have often used weak identifications
systems to impersonate real clients and steal
millions of dollars from insurers
(Xinhua) -- Kenya’s insurance
penetration rate could increase following a raft of
innovations by the sector.
of the biggest challenges facing the industry and
especially, the medical insurance sub sect or has
been rampant fraud caused by lack of clear
networks have exploited loopholes to circumvent the
security measures that have been deployed.
to the Insurance Regulatory Authority, the overall
insurance penetration in Kenya reached 3.1 percent
by the end of 2012. This compares unfavorably with
advanced economies where at least 20 percent of the
population is covered.
medical insurance is even lower at 1.75 percent of
the population. Stakeholders have blamed the low
uptake on high cost of premiums, in an environment
where a large segment of the population is
a few people are covered at high cost but for the
industry to thrive it needs a model where more
people are insured at a lower cost.
new innovation that leverages on Information
Communication and Technology could lead to an
increased penetration, as it helps to curb
fraudulent medical claims.
internet based system uses a biometric
identification system that identifies the user.
have often used weak identifications systems to
impersonate real clients and steal millions of
dollars from insurers.
system has developed an easy to use solution in the
management of medical schemes. The developer,
Siltech Systems, said that the software links the
doctors, insurance into one seamless interface.
Executive Officer James Wainaina said that the tool
relies on the client’s finger print which is
unique to every individual.
system then interrogates the database in real time
to know the extent to which the patient is
covered, as well as the limit provided,” he
the case, where a patient who is covered by an
employer leaves office, membership can be
deactivated immediately through the click of a
button,” he said.
system is cost effective and could lead to a
reduction of premiums charged by insurance
companies. “Hospitals and insurance firms only
have to pay a monthly access fee in order to use the
system,” Wainaina said.
Insurance Providers Association of Kenya (MIPAK)
Chairman Samuel Agutu said that smart card solutions
that are currently in the market are not compatible
with each other.
medical insurer has developed its own smart card
and this has necessitated hospitals to maintain
multiple systems,” Agutu said.
added that the paper based system has a lot of
inefficiencies as manual authorization is required
before patients can access healthcare.
has been a challenge especially when the person
authorizing cannot be reached,” he said. The
innovation eliminates the need for end of month
reconciliations, which the system carries out in a
real time basis.
reduces backlogs, which delays settlement of
claims and in the process makes the sector more
efficient,” he said.
Regulatory Authority Chief Executive Officer Sammy
Makove said that the industry is suffering heavy
losses as a result of fraudulent claims. “We are
therefore encouraging the sector to embrace
technology that will enhance the sector,” he said.
Head of Insurance Ben Waweru said that low
healthcare uptake has a negative impact on the
economy. He noted that the solution offers timely
identification of clients by making all parameters
also eliminates errors that could lead to over
expenditures and this saves the underwriter from
incurring losses. The system has also been designed
to cater for cases when internet connection fails.
have an arrangement with the telecoms to offer a
SMS platform to take advantage of Kenya’s high
mobile penetration rate, “ Waweru said. The
locally developed solution can be modified to meet
the needs of even the remotest villages.
Designer John Mutuma said that the software also
reduces the tendencies of doctors to collude with
patients in order to defraud the insurance company.
has a built in alert that notifies the
underwriters in case of any abnormal fees,” he
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