A Nairobi medical facility has moved to court seeking to compel the Social Health Authority (SHA) to pay Sh22.58 million for dialysis services allegedly offered to patients under the defunct National Hospital Insurance Fund (NHIF).
London Medical & Dialysis Centre argues that the unpaid amount relates to treatment provided to NHIF beneficiaries between 2022 and 2024, before the insurer was dissolved and replaced by SHA.
In the suit, the facility wants the court to order SHA to settle the outstanding Sh22,581,500 together with interest and the costs of the case.
According to court documents, the hospital was accredited and contracted by NHIF to provide medical and dialysis services to its members. It says it treated patients in accordance with the contract and submitted all claims electronically through NHIF's billing system.
"The plaintiff duly rendered dialysis and medical services to NHIF beneficiaries and submitted invoices through the prescribed electronic claims platform, but the amounts remain unpaid," the hospital states in its pleadings.
The facility says the outstanding claim comprises Sh247,000 for services rendered in 2022, Sh1,757,500 for 2023 and Sh20,577,000 for 2024.
It argues that when NHIF was dissolved on October 1, 2024, all its functions, assets and liabilities were transferred to SHA, making the authority legally responsible for settling the debt.
The hospital further claims that the delayed payments have severely affected its operations.
It says the failure to settle the claims has resulted in loss of revenue, difficulties in paying staff salaries and suppliers, delays in acquiring medical equipment and expanding its services, and increased borrowing to sustain operations.
However, SHA has opposed the suit and urged the court to dismiss it, insisting it does not owe the hospital the claimed amount.
In its response, the authority says its records indicate London Medical & Dialysis Centre received Sh76,966,302 in payments between January 2022 and August 26, 2024.
SHA adds that the hospital's remaining claims are still undergoing various stages of processing.
According to the authority, Sh588,500 has been marked for discharge, Sh152,000 has been forwarded to the branch office, Sh28,500 has been forwarded to accounts, while claims worth Sh5,578,500 are listed as accounts payable. It also says claims worth Sh57,000 were returned to the hospital, while claims valued at Sh9,500 were rejected.
"Any claims reflected as accounts payable remain subject to audit, validation, approval and allocation of funds in accordance with the applicable law and public finance management framework," SHA states in its court filings.
The authority maintains that the processing status of the claims does not amount to an admission of liability and argues that the hospital has not proved the services were rendered in compliance with contractual and regulatory requirements or that the claims were verified and approved for payments.
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