Health Cabinet Secretary Aden Duale has suspended 40 hospitals from the Social Health Authority program for allegedly engaging in fraudulent practices.
Speaking during a press briefing on Friday, Duale said the
facilities must comply with the rules and the regulations.
“These suspensions take effect immediately. During the
investigation period, these facilities will not receive any benefits from SHA,
and we will surcharge them for the money lost,” he said.
Duale said the government has also identified several health
professionals involved, including eight doctors in Nairobi, Bungoma, and
Kilifi.
“…any doctor or health official involved in defrauding SHA
will be held personally responsible,” he said.
He said they have flagged the growing tendency by some
facilities, both private and government, to fraudulently convert outpatient
cases into inpatient ones, particularly in Nairobi and Homa Bay.
“The fourth issue is multiple billing and ghost patients.
For example, in Mandera County, four different facilities submitted claims for
the same patient who was only admitted to one facility,” he said.
Duale said the Ministry will publish the names of the
suspended hospitals in a Gazette Notice after they are investigated by the DCI.
“We will hand over all the hospitals and the 12 health officials to the DCI for further investigations. Additionally, we have ordered the relevant regulatory bodies to cancel their licenses,” he said.
He said SHA has immediately withdrawn the user rights for these doctors and clinical officers from all the Authority platforms.
He said healthcare providers owe clients a duty of care as no medical procedure can be performed and paid for by SHA unless the relevant healthcare professional receives a One-Time Password (OTP) authorizing that procedure.
“Therefore, any healthcare provider whose information is used to defraud SHA shall be held personally liable as is the case for the eight doctors and the four clinicians. It is also criminal for any healthcare professional to induce provision of services with the intent of defrauding SHA,” he said.
