SHA: Govt Pays Over KSh 6.8 Billion in Claims to Hospitals Treating Kenyans Under New Medical Scheme
- The Social Health Authority (SHA) transitioned from the National Hospital Insurance Fund (NHIF) in October 2024
- SHA has recorded significant growth in 10 months since its implementation, with the number of registered members growing to 24 million
- The Ministry of Health revealed that the authority paid hospital claims in 10 months, amounting to KSh 6.8 billion
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.
The Ministry of Health has released data showing the progress in the implementation of Universal Health Coverage (UHC) under the Taifa Care programme.
Source: Twitter
According to the report, more than 24 million Kenyans have enrolled for the Social Health Authority (SHA).
How much has SHA paid hospitals?
The new medical scheme, which transitioned from the National Hospital Insurance Fund (NHIF), has treated 4.5 million Kenyans under the Primary Health Fund.
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This saw the SHA pay KSh 6,82 billion in claims to hospitals for the past 10 months from October 2024.
The authority said that about KSh 1.5 billion in claims are still under verification.
The number of Kenyan patients who have accessed specialised care under SHA stood at 2.2 million, with over 550,000 mothers supported.
Govt warns hospitals defrauding SHA
The report followed stern action taken by the Ministry of Health over fake claims presented by hospitals.
Health Cabinet Secretary (CS) Aden Duale warned Kenyans and medical practitioners against plots to defraud the Social Health Authority (SHA).
The CS said the hospitals and individuals defraud SHA via:
- 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.
- Double charging, where some facilities are billing both the SHA Fund and demanding cash payments
- Duale shut down 35 hospitals and facilities involved in SHA's fraudulent activities.
Source: Twitter
What you need to know about SHA
- CS Duale announced in June 2025 that SHA will no longer give hospitals unlimited reimbursements, but payments will be limited to the number of permitted beds.
- In September 2024, ahead of the SHA implementation, the government released an allocation of KSh 9 billion to settle the bills, including KSh 1 billion for Linda Mama.
SHA targets employers to recover KSh 21b
Meanwhile, the government launched a national compliance campaign, aimed at recovering over KSh 21 billion in outstanding Social Health Authority (SHA) contributions from employers.
The Ministry of Health revealed that more than 12,900 employers from Nairobi alone have been reported for defaulting in paying the necessary 2.75% monthly deductions, with arrears of more than KSh 3 billion.
According to SHA, employers are required to remit deductions by the 9th day of every month.
Proofreading by Asher Omondi, copy editor at TUKO.co.ke.
Source: TUKO.co.ke
