Relationship between risk mitigating measures and level of fraudulent claims at National Hospital Insurance Fund in Western Kenya region
Tago, Lemiso John
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Fraud has been a challenge to the all sectors of the economy and force many entities to develop proactive and reactive measures to mitigate the vice and reduce the impact of fraud risk. The study focused on the relationship between risk mitigating measures and level of fraudulent claims at National Hospital Insurance Fund in Western Kenya region being the general objective of the study. Specific objectives included to determine the relationships between surveillance program, information technology, clinical medical audit and monitoring by standard quality assurance officers and the level of fraudulent claims at National Hospital Insurance Fund in Western Kenya region. Fraud Triangle and Fraud Scale theories by Cressey (1973) and Albrecht (1984) respectively were used to guide the study. The study adopted causal research design because it shows the cause and effects of the relationship existed in independent and dependent variables and also the target population was 121 respondents from 11 branches of NHIF at Western Kenya region. In addition sample size of the study was 110 respondents who were selected using stratified sampling technique. Questionnaires were used to collect data. Instrument validity and reliability were attained through consultation of experts from Kenyatta University and Kuder Riachardson coefficient respectively. Data was analyzed using descriptive statistics, while regressions analysis was used to measure the relationship between risk mitigation measures and level of fraudulent claims by the aid of statistical packages for social science (SPSS) version 20. The findings revealed that there was strong relationship between surveillance program and clinical audit and level of fraudulent claims while information technology and monitoring by standard quality assurance officers shown moderate relationship with level of fraudulent claims which implied that risk mitigating measures impact the level of fraudulent claims. The study concluded that there was a relationship between mitigating measures and level of fraudulent claims at NHIF in Western Kenya region. It was recommended that surveillance program should be enhanced, information technology to be improved, officers to performing clinical audit be adequately trained, and competent quality officers with medical background employed to carry out monitoring effectively.