Senate probes SHA’s Sh6.3 billion police medical compensation contract

The Senate has initiated an investigation into allegations of collusion between the Social Health Authority (SHA) and private insurance companies over a Sh6.3 billion medical compensation contract for the National Police Service (NPS).

The inquiry follows concerns raised over delayed or denied compensation for officers injured in the line of duty.

These claims, initially covered under a contract between the NPS and the defunct National Health Insurance Fund (NHIF), have faced numerous challenges, including rejections and long processing times.

Eliud Kinuthia, the chairperson of the National Police Service Commission (NPSC), on Thursday revealed to the Senate Security, Defence, and Foreign Relations Committee that only a fraction of claims has been honoured.

"Out of 1,966 claims filed, only 937 worth Sh709 million have been paid. Additionally, 240 claims valued at Sh240 million were rejected, and 161 claims worth Sh108 million remain pending. A further 422 claims valued at Sh444 million are under internal review," Kinuthia said

Kinuthia also criticised the SHA for disregarding officers' concerns.

"NHIF can be arrogant toward us, and we have nowhere to turn. We've been disadvantaged because we lack unions to represent us and are left suffering in silence," he said.

Disputed contracts

The situation is further complicated by two separate contracts: one between NHIF and the police service, and another between NHIF and private co-insurers.

Augustine Wafula, the claims manager at SHA, attributed delays to conflicts arising from these agreements.

"There are two contracts. One reason for rejections is that some injuries, such as an officer being assaulted at home, are not covered under the contract," Wafula told the committee.

However, the NPSC dismissed these explanations.

Kinuthia noted that private insurers engaged by NHIF are not recognised by the police service.

"As the employer, we do not know these co-insurers. We have no agreements with them. NHIF must take full responsibility for their actions," he said.

Kinuthia also refuted claims that police injuries outside active duty do not qualify for compensation.

"A police officer does not sleep. We simply rest, because we are on duty 24 hours a day," he asserted.

Senator William Cheptumo, the Senate Committee chairperson, pledged to ensure justice for injured officers.

He held SHA accountable for the contractual mess, accusing the agency of failing to honour its obligations.

"The real enemy here is SHA, or NHIF. They may claim they are not answerable to the Insurance Regulatory Authority, but they are answerable to us. We will summon all co-insurers to explain these delays and rejections," Cheptumo said.