Health Cabinet Secretary Aden Duale has issued stern warning to health facilities involved in fraudulent claims under the Social Health Authority (SHA).
Speaking during a meeting with the Council of Governors (CoG) on Monday, April 14, Duale vowed tough action against those found exploiting the program.
He disclosed an instance where hospitals billed the National Health Insurance Fund (NHIF) for services never rendered.
“A facility said they have conducted 10 surgeries and because the system picks the surgeon, when the surgeon was called he was 500 kilometers away from that facility and he has never been there.
"We shall crack down on frauds who are claiming money from SHA for procedures done in different hospitals, yet no procedures have been carried out," he said.
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This comes two weeks after Duale announced the formation of the NHIF Pending Medical Claims Verification Committee to address the backlog of unsettled medical claims.
In a statement on Saturday, March 29, Duale said the committee will be chaired by James Masiro Ojee, alongside Vice-Chairperson Dr. Anne Wamae and consists of 17 members.
According to the CS, their primary task is to scrutinize all pending claims accumulated between July 1, 2022, and September 30, 2024.
The committee will also evaluate the legitimacy of the claims, ensuring that genuine submissions are settled while fraudulent or irregular ones are flagged for appropriate action.
“The Government has constituted the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee to address the backlog of unsettled medical claims.
"It will make recommendations on the settlement of genuine claims while identifying and flagging any fraudulent or irregular submissions for appropriate action," he said.
Beyond resolving existing cases, the committee was also been tasked with proposing long-term reforms aimed at preventing future claim backlogs.
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