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This Performance Audit Report presents the audit findings, conclusions and recommendations on controls of payments made by NHIF to accredited healthcare facilities. The audit focused on assessing whether the National Health Insurance Fund (NHIF) has set adequate control mechanisms for processing payments of claims of healthcare facilities to ensure that they are authentic, correct and complete.
This included an assessment of the processing of claims after the provision of health services to the entitled beneficiaries, control mechanisms and remedial actions taken due to malpractices conducted by healthcare service providers.
The audit covered three financial years, from 2019/20 to 2021/22.