Atwoli threatens to pull Cotu out of SHA Board over alleged grand corruption
He says the core challenge facing SHA is that it is entirely dependent on an IT platform remains under the full control of both DHA and the ministry of Health, instead of being independently managed by SHA itself
The Central Organisation of Trade Unions (Cotu) has threatened to pull out of the Social Health Authority (SHA) Board following revelations that Sh10.6 billion in claims has been lost due fraudulent practices such as upcoding, falsification of medical records, conversion of outpatient cases into inpatient admissions, and phantom billing for non-existent patients.
In a statement, Cotu Secretary General Francis Atwoli blamed failure by the ministry of Health to transfer the mandate of verifying and processing claims from the Digital Health Authority (DHA) to SHA for the fraud despite raising its concerns at Board level.
“It is the position of COTU (K) that unless SHA is given 100% control of its IT platform, workers will lose the faith and trust they have in the system and thus affecting affecting compliance and provision of services. COTU (K) has raised these concerns at Board level and if no action is taken, we shall be consider to reconsider our position. Indeed, we are considering whether to continue sitting on a Board that has no authority or withdraw entirely. To this end, COTU (K) will soon convene a meeting at Tom Mboya Labour College to deliberate on out continued participation on the SHA Board,” he said.
According to Atwoli, the core challenge facing SHA is that it is entirely dependent on an IT platform remains under the full control of both DHA and the ministry of Health, instead of being independently managed by SHA itself despite being established by an independent Act of Parliament that does not make it subordinate of either of them.
SHA, however uses the system to process and pay claims to hospitals, which Atwoli says has created serious loopholes since it has no authority to authenticate and verify hospital claims or determine who shall or should not be paid as a result of which it continues to be blamed for all misdeeds committed by DHA and the ministry.
He lamented that as a representative of workers, he is unable to explain to them what is happening at SHA considering that it is used as a conveyer to process payments yet it does not control the IT system aimed at addressing the very problems that plagued the defunct National Hospital Insurance Fund (NHIF).
“It is even more disturbing that SHA even though SHA has its own independent Board which must be allowed to function n line with the founding legislation, an amorphous entity, DHA, alongside the ministry of Health continue to make it play secondary to them,” he added.
Atwoli said that as representatives of workers, COTU (K) is deeply concerned that as they continue to faithfully contribute to Social Health Insurance in the understanding that SHA is fully in charge of the funds, it is unacceptable that their hard-earned money is managed through an “amorphous” arrangement where SHA and MoH control critical systems.
Atwoli’s statement came a day after Duale dismissed claims that money was lost by SHA through fraudulent claims last month, instead insisting that all payments paid were legitimate.
He added that claims worth Sh3 billion are being re-evaluated due to missing documents, while an additional Sh2.1 billion is under surveillance for further investigation.
The CS said that since the rollout of TaifaCare last October, SHA has received claims totalling Sh91.7 billion from hospitals under the Primary Health Care (PHC) and Social Health Insurance Fund (SHIF) schemes. Of these, Sh60.7 billion has been paid out, with Sh6.4 billion already approved and awaiting disbursement.
He explained that SHA’s digital claims system, rolled out in October last year, detects fraud at every stage of processing as a result of which 728 non-compliant health facilities have been shut down, with another 301 downgraded.
