Health Cabinet Secretary Aden Duale has said the government will take strong action against people and hospitals stealing money from the Social Health Authority (SHA) Fund.
Speaking in a statement, Duale said he’s deeply worried by the increasing number of fraud cases involving some hospitals, health workers, and even patients. He called their actions illegal and a betrayal of trust in Kenya’s healthcare system.
One of the tricks being used is hospitals lying about treatment. Some claim that patients were admitted (inpatients) when they only visited shortly for check-ups (outpatients), so they can get more money from the fund.
Duale warned that hospitals involved in these lies will be shut down, and those responsible will be taken to court.
He also mentioned that some hospitals are forcing doctors to admit people who don’t actually need to be hospitalized. This is done to make the bill higher and claim more from the SHA. If caught, both the doctors and the hospital owners will face punishment.
Surprisingly, some patients are also involved. After complaining about problems in the SHA, a few have started helping hospitals cheat. Some patients are giving hospitals their access codes, so false claims can be made for services that never happened.
Duale said this is a serious crime, and those involved could be arrested and taken to court.
The government also found that some doctors are wrongly sharing pre-approval codes to allow fake billing. Others are double charging—using SHA funds to pay for a service, and also asking patients to pay cash for the same thing. Duale said this is illegal, and asked anyone affected to call SHA on 147 and report it.
The most shocking scam is that some hospitals are making claims for “ghost patients” — people who don’t even exist. Some also lie about having more patients than their beds can actually hold, just to get extra money.
This is part of the government’s wider push to clean up the SHA program and stop fraud. In April this year, Duale had already begun cracking down on fake doctors and illegal clinics taking advantage of the insurance fund.
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