October 2018, Officers from DCI approached chief magistrates court saying they received information that there was misappropriation of funds at NHIF and to enable them conduct investigations they needed permission to conduct search.
They told the court they needed to conduct server system audit and imaging of Nairobi West hospital servers and carry any material evidence
“I have reason to believe that crucial material evidence in regard to investigations can be obtained from the respondents offices, private residences and business premises,” said police officer Nephat Marubu in a sworn affidavit in court.
And on that strength he successfully sought for permission to enter and inspect both the hospital and residences of the two doctors.
But in a quick move, the two doctors filed an application seeking to suspend implementation of the order for search saying it amounted to violation of their right to fair trial.
The two doctors were; Dr Umesh Saini and Dr Mina Saina. While Dr. Umesh Saini who’s the father to Jayesh Saini, a proprietor of NWH denied being an employee of the hospital, he wasn’t being totally honest.
Dr. Umesh day had come, following a trail by detectives, there was a scandal that had to be unearthed. The DCI obtained obtainedan order that required Dr Umesh Saini and Dr Mina Saina to produce books of account together with invoices and claims for payment of NHIF from 2013.
While he battledcorruptionaccusations on healthcare, Dr. Umesh was rewarded with the order of the grandwarriorof Kenya(OGW) in 2018, but his troubles were far from over. While he took a laid back position in active management, he gave his son, Jayesh the mantle, for an aggressive, eloquent, audacious character, he met the requirements.
Saini family are not new to corruption charges, in-fact the records are compelling. It’s not a shocker why despite all the accusations, they’ve never been successfully prosecuted.
February 2000, Jayish Saini and Umesh Saini for conspiring to defraud the government of Sh27M. They had allegedly falsely declared that 7,540 cellular blankets were delivered to the Ministry of Health by Gesto Pharmaceuticals had passed Kenya Bureau of Standards tests.
They committed the alleged offence between September 1, 1999 and November 4, 1999 in Nairobi. They were released on Sh5M bond.
Still with healthcare, perhaps the most popular heist Mr. Jayesh is know for is the Clinix Healthcare Ltd rip off.
In 2012, Parliamentary Committee on Health played tabled a report on allegations of irregularities in the civil servants outpatient medical insurance scheme in which Clinix was at the center, Jayesh was the owner.
Report had recommendedthat the Ethics and Anti-Corruption Commission investigates the roles of Medical Services Minister Anyang’ Nyong’o and Public Service Minister Dalmas Otieno on the alleged irregularities in the scheme. The committee was concerned with Prof Nyong’o’s involvement with Mr Jayesh Saini.
The committee had foundout that found out that over Sh30 million had been paid to six clinics under the Meridian brand on March 8 2012, more than three weeks before they were established.
The Parliamentary Health Committee had termed the offshore ownership of Clinix Healthcare Limited as an “Angloleasing-styled corruption scheme” even as it emerged that NHIF paid Sh91.3 million to outlets that did not existent at the time the facility was awarded a contract under the NHIF civil servants medical scheme.
Records tabled before the House committee showed that Clinix had 71 clinics countrywide, 49 of which were opened after the healthcare firm had signed a contract with NHIF to provide outpatient services under the civil servants scheme. Some 28 new outlets were established between April and May 2, 2012.
Documents presented before the committee by the hospital chain showed that Clinix Healthcare was owned 99 per cent by Antony Chako through Pharma Investment which was incorporated in the British Virgin Island, described by the team as “one of the world’s most notorious financial secrecy jurisdictions and tax havens”.
The remaining one per cent was held by Jiwan Dabral through Beneficial Ltd which is registered in Kenya.
Further, the committee concluded that the hospital chain lacked the human resource and technical capacity to provide healthcare services to the 56,747 principal members who chose the hospital chain as their preferred medical services provider under the state funded scheme for all public servants after a preliminary site visit to its Sameer and Daystar Athi River clinics.
“We know that Mr Jayesh Saini, of Clinix Healthcare and Nairobi West Hospital is the brainchild behind this new fraud being done under Clinix,” said Dr Robert Monda, the Health Committee chairman.
“Information we have from the registrar of the Medical Practitioners and Dentists Board indicates you have seven doctors registered by the statutory body,” he added.
A list of funds disbursed to health facilities for the period between January and March under the capitation scheme showed Clinix Healthcare Eldoret ‘B’ as having received Sh4,075,830 yet the facility was licensed to begin operations on March 16. “Allocations were given to ghost clinics and this constitutes fraud,” said Dr Monda.
Clinix CEO Zac Madana told members of the Health Committee that the firm received Sh202,161,137.50 from NHIF on March 13 as capitation for January to March, the first quarter.
“It costs an estimated Sh10 million to set up a clinic. It is not true that we are funding our expansion from the NHIF earnings,” said Mr Madana when he testified under oath before the Health Committee.
However, the Health Committee chairman Robert Monda said that the real face behind the healthcare enterprise is Mr Jayesh Saini, associated with Nairobi West Hospital.
Jayesh was eventually pushed out of business and left with a Sh200m suit over fraud. But with his firm foundation in the healthcare system, he coined yet another scheme.
With collapse of Clinix, Jayesh 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.
Nairobi County government has been on the spot for paying more than Sh652 million in excess of the medical scheme’s contract term of Sh1.07 billion.
According to the Auditor General’s report for the financial year ending June 30, 2018, City Hall made a total payment of Sh1.73 billion to AAR Insurance Kenya Limited although the contract sum was Sh1.07 billion.
“Although the total payment made so far to AAR Insurance Kenya Limited is Sh1, 725, 488, 939, no explanation has been given for paying Sh652, 786, 602 in excess of the contract sum of Sh1, 072, 702, 337,” read the report in part.
In addition, a comparison of the annual contract sum shows unexplained growth in value of the insurance cover even though there was decrease in number of staff by 402 during the year under review.
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 sh6 Billion at NHIF to over 12Billion budget annual.
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.
A Sh9B TSC tender that was floating attracted the attention of Mr Jayesh who as he’s been, rebranded again to win the lucrative deal.
Mr Saini rebranded his company to Bliss Healthcare and is a shareholder in an entity named Medical Administrators (K) Limited.
Curiously, Insurance Regulatory Authority (IRA) Chairman Abdirahin Haithar Abdi is a shareholder at Medical Administrators (K) Limited through proxy, which amounts to conflict of interest.
If the plan to award a multibillion tender to Medical Administrators (K) Limited to cater for health cover of over 318,000 teachers went well, the whole history could repeat itself.
How the body responsible for teachers welfare failed to conduct a due diligence still beats logic, but it is understood that money changed hands.
Further, Medical Administrators (K) Limited (Bliss) lacks proper hospital network to deliver services effectively to teachers across the country.
In yet another controversy, Jayesh’s Nairobi West Hospital is entangled with insurance broker Minet Kenya in a Sh170M claim over a deal with TSC.
Nairobi West Hospital early last year slapped insurance broker Minet Kenya with a lawsuit for failure to settle Sh170 million medical bills of teachers and members of national police service treated at the facility.
The insurance firm denies the bill, arguing that it has settled all outstanding claims and is asking the health facility to produce evidence.
The hospital entered into a one-year deal with Minet in October 2016 for provision of medical services to members of the Teachers Service Commission (TSC) and the National Police Service which was extended for one year after expiry of the previous contract.
At the heart of the dispute was a directive by Minet asking Nairobi West Hospital to send details of the patients within seven days of treatment.
The hospital said it declined the directive to share patients’ information every seven days due to a technical hitch stemming from Minet’s software that made it impractical.
Nairobi West Hospital further claimed that Minet approved all the services prior to the patients being attended to and therefore was fully aware of the outstanding bill.
But Minet denied the claim, arguing that the requirement to share the weekly data was part of a contract signed between the parties when it was renewed and therefore the hospital breached the agreement.
The insurance firm denied any liability arguing that it was not in control of the software that the hospital claims led to failure to it submitting weekly data.
The firm claimed that the software was under control of Bliss GVS Healthcare Limited(Owned by Jayesh) and that any further demand of payment should be settled by it.
Having not been satisfied and playing games, Minet settled Sh53 million that could be accountedfor during that period but rejected Sh170 million worth of claims.
In the backdrop of all these, the mainquestion is just how the system allows such red flagged characters to continuemanipulatingthe systemat thecost ofKenyanshealthcare. Is there a point where it’s said it’s endshere’. As authorities continue to buy time, the characters continues to get smarter and strategize on how and where to steal. The mega corruption between private entities and parastatals is disastrous.