Insurance cartel Jayesh Saini has been accused of bribing media to attack the National Hospital Insurance fund over a matter that has now been clarified by the National Hospital Insurance Fund CEO.
It is alleged that Mr Jayesh is also influencing the Public Accounts Committee (PAC) of the National Assembly to harass, humiliate and intimidate the NHIF for him to achieve his ill will.
The Sh200 million was a top-up to the Sh4.79 billion comprehensive medical insurance cover awarded to NHIF on September 26, 2017 to cushion members of the National Police Service who might exhaust their limits. The insurance cover was for two years from October 1, 2017 to September 30, 2019.
According to sources, Jayesh Saini wants NHIF to be denied the business for him to get the deal.
However, NHIF has clarified on the Ksh. 200 million was not lost because at the time the auditor general’s office did their analysis, they had not provided the documentation.
So why is Jayesh Saini after NHIF?
In the past NHIF used to do basic social cover in which it relied on the basic contributions frominformal and formal sector. With time NHIF grew expanded got approval from treasury and Attorney general’s office to expand and start offering medical social cover to state parastatals/ministries etc. The fund grew from less than 20 billion to current 60 billion net of collections.
Currently the fund has over 27 county governments plus several state departments i.e. ministry of interior (police) ministry of public service (civil servants medical covers, Kenya power and many more. During the time of Mr. Geffrey Mwangi before he was suspended on corruption allegations; He was able to grow the fund and even became a big threat to the private insurance providers.
On the several occasions lobbyists pushed the Insurance Regulatory Authority and legislatures to make amendments targeting the business portfolio and the control of state owned NHIF.
The insurance cartels lobbied unions to etc. promising kickbacks for the high premiums to be cut off NHIF but the former C.E.O Pushed them back by getting the AG and finance CS exonerating the fund from the finance bill. Since he left; the weak management at the fund has left loopholes that have been effectively used by cartels to bring NHIF down.
I give few examples; Nairobi got proposal of 800m for its staff they chose private at a cost of 1.4billion shillings. Kenya police services currently at 4.5billion they were at private rate previously with lower benefits at 6 billion. TSC spends over 12billion on medical yet the NHIF proposal was at 6 to 8 Billion.
Currently the government has been pushing for universal health and high penetration or uptake of NHIF by the informal sector. This prompted the counties to adopt NHIF to expand the enrolment in the rural and urban informal sectors. Pulling the state agencies out of NHIF will erode the public confidence and the absorption of NHIF by the informal sector. The state employees act as goodwill ambassadors for the fund absorption into the grass root. The fund covers senior state officials like ex-presidents and sensitive security agencies who need no disruptions during delays of non-payments by government to the private firms.
Last year the government delayed to pay group life for disciplined forces for nearly whole year the insurer who is pioneer refused to pay claims to injured/dead officers till they were fully paid premiums. The kind of interruptions of services were even experienced during AON –MiNET covering the police. They had to go back to the state-owned insurer who offer interrupted services while waiting for funding from treasurer since its nonprofit body.
The Cartel involved for lobbying for the NHIF sabotage has been involved in the same for several years. There are Company by the name Clinix. Clinix was once sued by the state for fraud of NHIF funds to a tune of over 200 million. Clinix is part of Nairobi West Hospital and associates with the foreign investors trading under GVS/BLISS Health Services.
Under Clinix/Nairobi West Hospital/GVS BLISS Clinics/medical administration Kenya ltd all have a common factor director and broker called Jayesh Saini.
Jayesh Saini, once he was pushed out of business at NHIF, went slow on Clinix and came up with GVSBLISS/ Clinics which has offices in Dubai and also has big role in Nigeria where the social insurance is dead.
This group came with same module of providing health services like NHIF under module called capitation in which clients are restricted treatment in their group of clinics and specific hospitals.
After this they approached Nairobi then under Evans Kidero convinced him with the deal then tender documents were manipulated and strictly required companies to quote on the capitation module only. This kind is only provided by Clinix/GVS/NRB West or NHIF. By doing this since they could not tender directly as hospital yet it is required for insurance they encrypted in or hide behind AAR Insurance Company. So, AAR tenders but it acts as a broker for this cartel that it takes most of the premiums and operates behind the umbrella of AAR. They have held the business for over 8 years being paid premiums of above 1.4 Billion annually.
Next came on board TSC tenders. They lobbied the union and commission to pull out of
NHIF. They attached tender document was prepared together with the cartel with
specifications that blocked all other brokers from participating. The requirements were
only made by one user minet insurance brokers that has also held the business for over
5 years. MiNET was used by Clinix as an umbrella for the tender jointly bring on board
other parties like Jubilee for medical and Pioneer Insurance for Group Life. The tender
for TSC was done end of last year with very inflated figures. The cost of TSC shot up from
6Billion at NHIF to over 12Billion budget annual. Below are opening results for 2019
Option 1. 49,570,865,110 billion.
Option 2. 24,393,004,750 billion.
Option 3. 45,341,699,576 billion.
Option 4. 35,220,512,500 billion.
Bid bond Geminia 180 million.
Rainbear Insurance brokers.
Option 1. 146,017,216,603 billion.
Option 2. 70,916,174,061 billion
Option 3. 110,320,112,450 billion
Option 4. 94,168,682,906 billion
No bid bond. Betn Direct Insurance.
Opton 1. 201,428,201,567 billion.
Option 2. 98,549,000,000 billion.
Option 3. 122,100,000,325 billion.
Option 4. 80,000,000,000 billion.
No bid bond Note Other than MiNET Insurance Brokers the other two are fake companies that brought in tenders to create the number that the tender was competitive and not non-responsive the companies don’t exist. All other brokers refused to participate even complained to PPRA and the completion authority but no action taken. So, the cartel created bids without bond and high prices hence winning the multibillion tender irregularly.
The same format has been used to lure various counties into to the fraudulent capitation scheme by Clinix/GVS/BLISS/NRB West Hospital /medical administration Kenya ltd. They are able to push high insurance cost or load premium it is paid to the umbrella insurance company that pushes the same to GVS/BLISS/Clinix/NRB West Hospital/ medical administration Kenya ltd. This money is then cashed out through the hospitals and channeled back to the state officers. EACC has been investigating Nairobi County of fraudulent excess payments over 300 million on top of 1.4 billion to AAR Insurance Company. They are yet to conclude the case.
Prior to the Treasury instructing NHIF to pull out of state insurance they were meetings held with regulator (IRA) CEO and this group of cartel currently targeting the Police Medical Insurance Scheme and Civil Service Insurance Scheme. TSC kickbacks exceed 2 billion shillings to the union/ TSC secretariat state investigative and compliance authority hence no amount of complains ever gets investigated.
As we speak the tender document from National Police Service has been prepared with the input of the leading insurance provider/minet and Clinix/GVS/BLISS Group. They will be using the leading insurance company in medical as the umbrella bidder hence remain undetected at the back ground.
They have already pushed for increase allocation of funding from current 4 billion to NHIF to over 5 billion to cater for various interested groupings. The same has been done to the Civil Service medical that is being lobbied for more than 8 billion shillings.
As funds dry in dams/roads and other projects all eyes have been turned into the cash cow NHIF. Once this medical scheme are pulled out of NHIF the only beneficiary of the same will be.
i. Clinix/GVS Bliss/NRB West Hospital/ medical administration Kenya ltd
ii. Minet Brokers
iii. Pioneer Insurance is given Group Life.
iv. Jubilee Insurance back up underwriter and umbrella tenderer supported by medical administration Kenya ltd Majority of the money is channeled out to Dubai and India by Mr. Jayesh into the directors of GVS/BLISS who are largely operating in Nigeria with offices in Dubai and India.
After complains were raised over the TSC medical /police medical and poor services by then the umbrella tenderer AON minet and AAR insurance the Cartel lend by JAYESH SAINI OF INDIAN ORIGIN have changed tact now instead pf using AON MINET as the administrator the group registered a medical administration co. called Medical administration Kenya ltd with the current CEO of MiNET Mr. Sammy Muthui having hidden interest together with Jayesh. Jointly they have in cooperated Jubilee insurance with former KWS ceo kipngetich being in the loop This they have organized manipulated the tender for national police medical Changed the specs to fit into jubilee and BLISS/Clinics/Kenbright brokers acting as the actuarial servicers co. The medical proposal by NHIF was at 4.5billion with free last expense. They have convinced treasury interior MINISTRY increase this to 6 billion 1.5b more than what is paid to NHIF the tendered will be jubilee insurance co.
Having blocked all other underwriters by adding a clause that the lead underwriter in the consortium must be having done medical for past two years above 5billion shillings yet in Kenya its only jubilee and AAR insurance co with that capacity and they are both silently working together other aspects in the tender look similar to the TSC tender that the same cartel manipulated with fake bidders but the GVT ignored to investigate since its ministry is allied to the Head of state.
This week the national police did an addendum in which they added 250 thousand last expense benefit this will also increase the cost of the tender by another nearly 500 million shillings yet the same benefits are offered under the group life/last expense cover for 2.5billion by pioneer insurance co. which has failed to pay claims to several police families but yet contracts have been renewed continuously for 8 years.
Once the tender is awarded to jubilee insurance as planned the money will be off loaded to medical administration Kenya ltd Jubilee insurance will remain with small percentage like 20% and small amounts paid to CIC and Madison.
Last expanse money will be forwarded to pioneer insurance company just like they have done in the TSC and other state tenders. JAYESH will the forward over 1.5billion in excess to the state officials behind the tender. Why ist that Asians/Chinese have always stolen state money but there’s no single prosecution of the same. Mr Jayesh last week had a case in court over fraud involving NHIF AND HIS chain of substandard clinics yet the same state is doing business with him behind the back.
MR Jayesh openly brags that He has the EACC/DCI KINOTI/interior ministry under control no amount of complains can achieve results that he single handedly influenced the fall in NHIF since they were playing had ball with his medical facilities. Attached are several complains about the jubilee and the other cartels working closely with Jayesh but DCI seems to have ignored the same.