1,118 clinics suspected of fraud as SHA collections hit Sh70 billion - Mwangangi
Mercy Mwangangi revealed that the authority has already rejected Sh10.7 billion in claims deemed fraudulent out of a total of Sh80 billion submitted by health facilities nationwide.
The Social Health Authority (SHA) has accumulated Sh70 billion from contributors since its creation, outpacing the defunct National Health Insurance Fund (NHIF), which managed Sh45 billion in total.
SHA Chief Executive Officer Mercy Mwangangi, speaking on Citizen TV on Tuesday night, provided a breakdown of the inflows: Sh8 billion directed to primary health care, Sh5.9 billion for the emergency and chronic illness fund, Sh54 billion allocated to the Social Health Insurance Fund (SHIF), Sh4 billion from public servants, and Sh500 million from local sources.
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She revealed that the authority has already rejected Sh10.7 billion in claims deemed fraudulent out of a total of Sh80 billion submitted by health facilities nationwide.
SHA continues to review the remaining claims to uncover further irregularities.
“Our law is very clear. If you submit a fraudulent claim to SHA, there are contractual terms that govern what SHA would do, including fines and criminal prosecution,” Mwangangi said.
According to the CEO, SHA has referred a list of 1,118 health facilities suspected of fraud to the Directorate of Criminal Investigations (DCI).
Among these, 85 facilities were confirmed to have engaged in deliberate fraudulent activities, while 151 were found to have submitted false claims or operated beyond their licensed care levels.
Addressing concerns about patient privacy, Mwangangi assured that SHA adheres to the law when handling data. Patients give consent when they visit facilities and submit claim forms.
"The data that the DCI will have is governed by the data protection in our Act and Digital Health Act (DHA) that protects patient data. It's within the law," she explained.
"There's no way we will know if the claim is legitimate if we can't access the claim and determine it took place, how would SHA pay, on trust? We can't."
On enrolment, Mwangangi stated that 26 million Kenyans are now registered with SHA. Of these, 890,000 come from the informal sector, and 4 million are salaried contributors, bringing the total number of active contributors to 4.8 million.
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