- The government has issued a warning about deceptive practices occurring within the Social Health Authority (SHA) claims procedure.
- Health Cabinet Secretary (CS) Aden Duale announced this nine months following the transfer of the National Hospital Insurance Fund (NHIF) to the SHA.
- Dueling cautioned Kenyans and health institutions about these practices, mentioning that 35 medical centers have been shut down.
Health Cabinet Secretary (CS) Aden Duale has cautioned both Kenyan citizens and medical professionals about schemes aimed at defrauding the Social Health Authority (SHA).
Duale identified deceptive practices under the new health program, which replaced the National Health Authority (NHIF) in October 2024.
What fraudulent activities occur at SHA?
On Sunday, June 29, Duale announced in an official statement that certain healthcare institutions, employees, and individuals seeking medical services have been involved in illegal practices.
"We have observed with significant worry an increasing pattern of deceptive practices conducted by certain healthcare providers, medical professionals, and sometimes patients against the funds managed by the Social Health Authority (SHA). Such acts are not only unlawful but also morally wrong and a clear violation of the confidence entrusted in our healthcare framework," stated Duale.
The CS pinpointed the subsequent practices as actions fraudulent enough to defraud the authority of billions of shillings:
- Falsification of assertions by changing outpatient claim records to appear as inpatient claims.
- Compulsory hospitalizations induced by pressure on healthcare professionals to admit patients unjustifiably in order to boost reimbursement amounts.
- The misuse of patient identification codes occurs when individuals share their access codes with hospitals for the purpose of claiming fraudulent services that were never actually provided.
- Misuse of pre-authorization codes by physicians
- Admission of 'phantom' patients. These refer to individuals who either do not actually exist or surpass the hospital’s physical limit.
- Some facilities are engaging in double charging by submitting claims to both the SHA Fund and requesting direct cash payments from patients for identical services.
What actions are implemented for SHA fraud?
CS Duale stated that such activities hinder the progress of universal healthcare initiatives, emphasizing that the government will not shy away from taking decisive and rapid measures against anyone or any organization determined to be responsible.
He declared the shutting down of approximately 35 private healthcare centers involved in the illicit practices.
The impacted facilities are located in the counties of Kisumu, Bungoma, Busia, Nairobi, Kilifi, Mandera, Wajir, and Kajiado.
The CS mentioned that they would forward the details of suspected facilities, healthcare providers, and patient records to the Directorate of Criminal Investigations (DCI) for additional inquiries.
More to follow...