SHA: Aden Duale Flags Fraudulent Activities in New Govt Health Scheme, Shuts Down 35 Hospitals
- The government has raised a red flag over fraudulent activities in the Social Health Authority (SHA) claims process
- Health Cabinet Secretary (CS) Aden Duale made the announcement nine months after the transition of the National Hospital Insurance Fund (NHIF) to SHA
- Duale warned Kenyans and healthcare facilities against the listed activities, saying that 35 hospitals have been closed
Wycliffe Musalia has over six years of experience in financial, business, technology, climate, and health reporting, providing deep insights into Kenyan and global economic trends. He currently works as a business editor at TUKO.co.ke.
Health Cabinet Secretary (CS) Aden Duale has warned Kenyans and medical practitioners against plots to defraud the Social Health Authority (SHA).
Source: Twitter
Duale flagged fraudulent activities under the new health scheme, which transitioned from the National Health Authority (NHIF) in October 2024.
Which fraud activities are at SHA?
In a public notice released on Sunday, June 29, Duale stated that the fraudulent activities are perpetrated by some healthcare facilities, workers, and patients.
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"We have noted with great concern a growing trend of fraudulent activities being perpetrated by some healthcare facilities, healthcare workers, and even patients against the Social Health Authority (SHA) Fund. These actions are illegal, unethical, and a direct betrayal of the trust placed in our health system," said Duale.
The CS identified the following practices as aimed at defrauding the authority of billions of shillings:
- Misrepresentation of claims through the conversion of outpatient claims into inpatient claims.
- Forced admissions through coercion of health workers to admit patients unnecessarily to increase claim values.
- Misuse of patient codes, where patients are sharing their access codes with hospitals to fraudulently claim services not rendered.
- Abuse of pre-authorisation codes by doctors.
- Admission of 'ghost' patients. These are patients who do not exist or are exceeding the hospital's physical capacity.
- Double charging, where some facilities are billing both the SHA Fund and demanding cash payments from patients for the same services.
Which action has been taken on SHA fraud?
Source: Twitter
CS Duale said that these activities undermine universal healthcare efforts, noting that the government will not hesitate to take strong and swift action against any individual or institution found culpable.
He announced the closure of some 35 private health facilities implicated in the fraudulent activities.
The affected facilities are in the counties of Kisumu, Bungoma, Busia, Nairobi, Kilifi, Mandera, Wajir, and Kajiado.
The CS said the ministry will submit suspected facilities, medical workers and patient files to the Directorate of Criminal Investigations (DCI) for further investigations.
What Kenyans said about SHA fraud
The announcement sparked debate among Kenyans, who questioned the viability of the new health scheme.
The majority of Kenyans argued that the government transitioned NHIF to SHA on account of preventing similar fraud that saw multi-billion shillings lost from the defunct scheme.
President William Ruto's administration has also procured a technology system worth KSh 104 billion from a Safaricom consortium to curb fraud.
This controversial deal formed the basis of discussion among Kenyans after CS Duale announced the closure of the 35 health facilities.
Proofreading by Mercy Nyambura, copy editor at TUKO.co.ke.
Source: TUKO.co.ke
