40 hospitals, 8 doctors, 4 clinicians suspended in SHA graft crackdown

The Ministry of Health has suspended 40 health facilities, eight doctors and four clinicians from accessing services under the Social Health Authority (SHA) for allegedly engaging in fraudulent activities.

In a statement issued in Nairobi on Thursday, the Ministry said the suspensions, effective immediately, follow a comprehensive digital audit and forensic review of suspicious claims lodged over the past two months.

“These facilities and professionals have engaged in corruption and theft of public resources. We will surcharge them to recover any money already paid on the basis of these fraudulent claims,” the statement read.

The list of suspended facilities has been published in the Kenya Gazette and includes hospitals in Nairobi, Homa Bay, Bungoma, Mandera, Kakamega, Busia, Kilifi, Wajir, Kajiado and Kirinyaga counties.

The Ministry noted that the audit exposed four main ways in which hospitals were defrauding SHA. These included upcoding, where facilities claimed payment for costlier procedures than those actually performed.

A hospital in Nairobi was said to have billed Sh201,600 for a transurethral resection of a bladder tumour despite only carrying out a prostatectomy costing Sh89,600.

Keep Reading

Others were falsifying medical records, like a facility in Bungoma that submitted claims for a patient who was, according to records, admitted to another hospital at the same time. Some hospitals, particularly in Nairobi and Homa Bay, were found to be converting outpatients into inpatients or exaggerating simple outpatient visits into extended hospital stays to claim more money.

In Mandera, four facilities were discovered colluding to lodge duplicate claims for the same patient, effectively creating ‘ghost patients’ to siphon funds from the scheme.

“These activities undermine public trust in our health system and threaten the feasibility of the Social Health Authority,” the statement said.

Eight doctors linked to facilities in Nairobi, Bungoma and Kilifi, and four clinicians from Nairobi and Homa Bay, have been found to be directly involved in the schemes.

The Ministry has revoked their access to SHA and Digital Health Authority platforms, and notified the Kenya Medical Practitioners and Dentists Council (KMPDC) and the Clinical Officers Council (COC) for immediate disciplinary action, which could lead to licence cancellation.

“No medical procedure can be performed and paid for by SHA unless the relevant healthcare professional receives a one-time password authorising that procedure. Any provider whose details are used to defraud SHA will be held personally liable,” the statement added.

The Directorate of Criminal Investigations will also receive the full list of implicated facilities and professionals for possible prosecution.

The crackdown follows President William Ruto’s recent warning that the fraudulent activities seen under the defunct National Health Insurance Fund (NHIF) will not be tolerated in the SHA era.

“If you made money under NHIF, you better look for another business. You cannot do those things you used to do,” the statement warned.

The Ministry also cautioned patients against sharing their SHA one-time passwords (OTPs) or identification details with anyone, noting that some level 2 and 3 facilities have been using them to process fake claims. Plans are underway to roll out biometric verification at these lower-level facilities to curb abuse.

“Where you share your OTP and it is used to defraud the SHA, you will also be held liable,” the statement said.

The Ministry is urging Kenyans to report suspected fraudulent activities directly to SHA via hotline 147. It commended whistleblowers who had exposed cases where patients were billed twice with facilities charging SHA and demanding out-of-pocket payments from patients.

“That will not happen under our leadership and our digital health system. Every cent contributed by Kenyans must be used to provide legitimate, quality healthcare,” the statement emphasised.

The Ministry reminded citizens that primary healthcare services, including outpatient consultations, medication and laboratory tests at public, private and faith-based facilities are fully covered by the government through the Primary Healthcare Fund, which has a budget of Sh13 billion this year.

“If you are told to pay for outpatient care at a dispensary, health centre or level 4 facility, report it immediately. Co-payment is criminal in law,” the statement noted.

The Ministry says the suspended hospitals will only be reinstated after meeting corrective measures ordered by regulators such as the KMPDC.

“For those coming to our offices to lobby for these facilities, you are wasting your time. Comply with the corrective actions first,” the statement said.

It added that the crackdown will continue, backed by SHA’s real-time digital monitoring system. “The moment you try to defraud, we will know. Our forensic auditors will be at your doorstep.”

With more than 25 million Kenyans now registered under SHA, the government says it is determined to protect the scheme from collapse.

“Our resolve is unwavering. We will protect this social health insurance so that it serves hardworking and responsible Kenyans who pay faithfully for their cover,” the statement concluded.