Duale puts hospitals, patients on notice over SHA frauds
CS citeS reports that some facilities are coercing health workers to admit patients unnecessarily to increase claim values
Health Cabinet Secretary Aden Duale has warned healthcare facilities, healthcare workers and patients engaging in fraudulent activities through Social Health Authority (SHA) Fund that they will face punitive actions.
In a statement, Duale said the actions are illegal, unethical, and a direct betrayal of the trust placed in our health system and will not be tolerated.
The alleged fraud includes misrepresentation of claims where some facilities are said to be converting outpatient claims into inpatient claims, which the CS said it a serious offence.
He threatened to shut down any facility found engaging in this malpractice immediately and prosecute those involved.
Duale also cited reports that some facilities are coercing health workers to admit patients unnecessarily to increase claim values.
“This is unacceptable. Facilities and health workers found colluding in this practice will face disciplinary and legal action. Every health worker is reminded to adhere to medical best practices. Both individual practitioners and facility owners will be held personally accountable for any fraudulent activity,” he said.
Duale also said the ministry is aware of cases where patients are sharing their access codes with hospitals to fraudulently claim services not rendered, adding it constitutes criminal fraud.
“Any patient, doctor, or facility involved will be prosecuted to the full extent of the law.”
Another tactic used by health facilities to siphon SHA funds is the abuse of pre-authorisation codes by doctors who share or misuse them to defraud the Fund will face prosecution with Duale saying such conduct violates professional ethics and the law.
At the same time, he said some facilities are claiming admissions for patients who do not exist or are exceeding their physical capacity to house patients, terming it a clear fraud which will lead to immediate closure and legal action.
Duale also said some facilities are billing both the SHA Fund and demanding cash payments from patients for the same services.
“This is illegal. Patients are encouraged to report such cases by calling the SHA Call Centre on 147. Fraud against the SHA Fund undermines universal healthcare efforts and harms every Kenyan. We will not hesitate to take strong and swift action against any individual or institution found culpable. Let this serve as a final warning,” he said.
