The Social Health Authority (SHA) has taken decisive action in a sweeping crackdown on health sector fraud. In a Gazette Notice released Tuesday, SHA Chief Executive Officer Dr. Mercy Mwangangi announced the suspension of 45 additional health facilities across various counties for their involvement in fraudulent activities against the national health insurance system.
This latest suspension brings the total number of affected facilities to 85, following a previous move earlier this month where 40 facilities were flagged and suspended for similar offenses.
The suspended facilities are accused of a range of fraudulent activities, including: Billing for services never rendered, registering ghost patients, falsifying medical records, upcoding minor illnesses to more serious ones to inflate claims and converting outpatient visits to inpatient claims.
These actions not only defraud the government but also undermine the integrity of the healthcare system and compromise services for genuine patients.
Dr. Mwangangi stated that the SHA is committed to upholding accountability and transparency in the health sector.
” We will not tolerate misuse of public funds or exploitation of patients. These suspensions are a clear warning to facilities that profit over ethics,” she said.
Under Section 48(6) of the Social Health Insurance Act, 2023, the listed facilities will no longer be eligible for reimbursements, payments, or any benefits under the Social Health Authority during their suspension period.
The SHA has further indicated that investigations are ongoing, and more facilities could face similar action in the coming weeks.
Facilities named in the Gazette Notice span counties including Nairobi, Kisumu, Garissa, Mandera, Homa Bay, Kisii, Uasin Gishu, Kakamega, and Turkana, among others.
Members of the public are encouraged to report suspicious health facility activities and verify facility registration status before seeking services.