The Ministry of Health has issued a warning over the rise in fraudulent activities targeting the newly established Social Health Authority (SHA) fund.
In a statement on Sunday, June 29, Health Cabinet Secretary Aden Duale condemned a series of malpractices, warning that those involved will face severe consequences.
"We have noted with great concern a growing trend of fraudulent activities being perpetrated by some healthcare facilities, healthcare workers, and even patients against the Social Health Authority (SHA) Fund.
"These actions are illegal, unethical, and a direct betrayal of the trust placed in our health system," the statement read.
Among the serious violations cited are facilities that convert outpatient claims into inpatient ones in order to inflate bills.
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"Misrepresentation of Claims: Some facilities are fraudulently converting outpatient claims into inpatient claims. This is a serious offense. Any facility found engaging in this malpractice will be shut down immediately and prosecuted," the statement continued.
Duale also raised alarm over forced admissions, warning that anyone found engaging in such a practice will be held personally accountable.
"Reports indicate 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," the statement added.
Duale also noted that misuse of patient access credentials has also been flagged as a growing concern.
"We are aware of cases where patients are sharing their access codes with hospitals to fraudulently claim services not rendered. This constitutes criminal fraud. Any patient, doctor, or facility involved will be prosecuted to the full extent of the law," the statement further read.
Other violations include the abuse of pre-authorization codes and the admission of nonexistent patients.
"Doctors who share or misuse Pre-Authorization codes to defraud the Fund will face prosecution. Such conduct violates professional ethics and the law.
"Some facilities are claiming admissions for patients who do not exist or are exceeding their physical capacity to house patients. This is clear fraud and will lead to immediate closure and legal action," the statement indicated.
Duale also revealed instances of double charging, where patients are billed even after claims are submitted to the SHA fund.
"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 Center on 147," the statement read.
In his closing remarks, Duale emphasized the impact of these scams on efforts to achieve universal health coverage.
"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," the statement concluded.
