SHA SCANDAL: Fake Claims, Unpaid Bills & Hospitals Revolt
Due to ongoing disagreements between the Social Health Authority (SHA) and healthcare providers, medical services in private hospitals have been disrupted for some government employees. In response, SHA has announced several measures to tackle the issue, including seeking help from investigative agencies.
On Wednesday, State House Spokesperson Hussein Mohamed and State House Economic Council Advisor Moses Kuria released a statement on behalf of SHA. The statement revealed that some hospitals had submitted fraudulent claims. To address this, SHA has asked investigative agencies to audit the claims and verify their authenticity.
The authority also commented on outstanding payments owed to hospitals by the now-defunct National Health Insurance Fund (NHIF). While some claims are valid, officials have noticed that certain hospitals rushed to submit additional claims just before SHA took over, possibly to create unnecessary financial burdens.
“The investigative agencies are handling the matter, and soon, genuine claims will be identified while false ones will be dealt with accordingly,” the statement said.
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This announcement followed a move by the Rural and Urban Private Hospitals Association of Kenya (RUPHA) to stop treating government-insured patients. On February 20, RUPHA stated that from Monday, February 24, their hospitals would no longer offer services to certain civil servants covered by government-backed insurance.
Rev. Joseph Kariuki, RUPHA’s Deputy Chairperson, confirmed this decision, saying, “Starting Monday, we will stop treating some government employees under this insurance scheme.”
In response, SHA Chief Executive Officer Robert Ingasira reassured patients that the government was working tirelessly to resolve the issue. However, he acknowledged delays in payments to some hospitals, citing problems with pending bills as the main cause.
Changes in the Payment System
SHA has also announced adjustments to the payment process for patients. From March 1, 2025, patients will receive an SMS notification once the hospital has been paid for their treatment.
“This will ensure transparency, and no one will be misled,” SHA stated.
SHA SCANDAL: Fake Claims, Unpaid Bills & Hospitals Revolt
