SHA Breaks Silence Over Missing Hospital Payment Claims

The Social Health Authority (SHA) has denied claims that a list of payments made to hospitals has gone missing, and has dismissed reports that it disabled the Kenya Master Facility Registry — the tool responsible for tracking such payments.
In a statement released on Tuesday August 26, the SHA described such reports as inaccurate and emphasised that it would keep Kenyans informed as the matter progressed.
“This information is inaccurate. SHA remains committed to keeping Kenyans informed and will continue to provide updates on key issues,” SHA noted.
“Please look out for more information as we keep updating our site,” the Authority added.
The records, which had been available for access to public, had become inaccessible on the evening of Monday, August 25. This incident raised eyebrows as it coincided with a statement released by Health Cabinet Secretary Aden Duale exposing massive fraud at the Authority.
At the same time, the Kenya Master Health Facility Registry (KMHFR), which contains details of facilities accredited by SHA, including their location, category, bed capacity, and services offered, among others, went down, making it difficult for the public to verify hospital details and track payments.
It comes amidst growing uproar over a scandal at SHA amounting to billions of shillings over suspected irregular disbursements, including payments made to ghost facilities.
After the removal of information and disabling of the registry, many interpreted the move as one aimed to curtail transparency and obscure financial dealings or unpaid claims.
On Monday, August 25,Duale exposed massive fraud at SHA, with investigations uncovering disturbing trends,including upcoding, falsification of medical records, converting outpatient visits into inpatient admissions, and phantom billing for non-existent patients.
He announced a crackdown on facilities defrauding the Authority, further informing that claims worth Ksh10.6 billion had been rejected due to fraudulent activities or non-compliance.
Duale also detailed thatclaims submitted by health facilities under the Social Health Insurance Fund (SHIF)totalled Ksh82.7 billion. Out of this, Ksh53 billion has been paid, Ksh6.4 billion has been approved and is awaiting disbursement, and Ksh10.6 billion worth of claims were rejected due to fraud and non-compliance.
According to the Ministry, facilities under the Primary Healthcare Scheme (PHS) submitted claims worth Ksh9 billion, of which Ksh7.7 billion has already been paid. The balance will be cleared in the next cycle.
An additional Ksh3 billion worth of claims were under re-evaluation due to missing documentation, while Ksh2.1 billion was being investigated for possible fraudulent activity. Claims worth Ksh7.6 billion for the month of August were also said to be under review.