Fraud Management Strategies and Performance of Medical Insurance Providers in Nairobi City County – Kenya
Loading...
Date
2024-01
Authors
Kinyuru, Maina Antony
Njuguna, Njeri
Journal Title
Journal ISSN
Volume Title
Publisher
IJARKE
Abstract
Globally, medical insurance is pivotal in financing healthcare, significantly impacting the performance of healthcare systems.
However, the effectiveness of this contribution is hindered by the pervasive issue of medical insurance fraud, which poses a
serious challenge to cost-effective healthcare systems worldwide. Over recent years, medical insurance providers operating in
Kenya have consistently reported dismal performance. An alarming 70 percent of medical insurance providers have sustained
underwriting losses for a continuous period of more than five years. This chronic underperformance is primarily attributed to
the persistent fraudulent activities plaguing these companies. The primary objective of this study was to evaluate the effects of
fraud management strategies on the performance of medical insurance providers in Nairobi City County, Kenya. To achieve
this, the study's specific objectives delved into investigating the influence of fraud prevention on medical insurance providers
in Nairobi City County, Kenya. The study adopted a mixed research approach of both qualitative and quantitative research
methods and employed a descriptive and explanatory research design, which is cross-sectional in nature. The target population
consisted of 2891 employees from the 27 listed medical insurance providers operating across Nairobi City County in Kenya.
The study's findings revealed a positive and significant influence of fraud prevention strategies on the performance of medical
insurance providers. The study found that MIPs should strengthen internal controls and review existing processes to recognize
vulnerabilities. This would mean implementing additional checks and balances to prevent similar fraud schemes in the future.
Description
Article
Keywords
Fraud Management, Medical Insurance, Insurance, Kenya
Citation
Kinyuru, M. A., & Njuguna, N. INTERNATIONAL JOURNALS OF ACADEMICS & RESEARCH.