Health Cabinet Secretary Aden Duale has accused hospitals of masterminding the loss of billions from the Social Health Authority (SHA), revealing that Ksh11 billion went missing due to fraudulent claims by health facilities.
Speaking on Wednesday, January 28, during the Members of Parliament retreat in Naivasha, Duale addressed recent reports indicating massive theft from SHA, explaining that the losses occurred when the national insurance provider paid for services that were never delivered.
“The Ksh11 billion lost is in the sense that some hospitals submitted claims, but we caught them. Some of them have gone to court, and some of them have agreed to return our money, but we are not done with them. We have the names of the institutions which we can publish. Most of the loss comes from rejections because they made claims for services that they have not offered, and many other things that I informed you on,” Duale told MPs.
According to Duale, private hospitals were the main culprits in submitting false claims, followed by some public facilities and even national referral hospitals like Kenyatta National Hospital. Faith-based medical facilities were credited with the fewest irregularities.
The CS confirmed that the Directorate of Criminal Investigations (DCI) is actively assisting with investigations and vowed to recover every shilling lost to fraud. Some hospitals have already been removed from the SHA program.
Duale also raised concerns about patient safety, noting that some medical facilities reportedly forced mothers to undergo unnecessary caesarean sections to inflate claims.
“We are closing down facilities that put patients’ lives at risk just to claim higher reimbursements,” he said.
So far, the Ministry of Health has closed 1,118 facilities, and Duale said the introduction of the Green Label Chart will help prevent further misreporting of claims.
The revelations drew criticism from some lawmakers. Mumias East MP Peter Salasya described the SHA fraud as evidence that the healthcare system had collapsed under President William Ruto’s administration, calling for the immediate dismissal of CS Duale and his team.
Meanwhile, Irungu Nyakera claimed that SHA had been created as a new channel for siphoning public funds.
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