The Social Health Authority (SHA) has urged Kenyans to verify their hospital bills and visit details every time they access healthcare services at medical facilities contracted under the scheme.
In a public notice on Thursday, October 9, SHA CEO Mercy Mwangangi advised members of the public to ensure their hospital visits are accurately recorded in the SHA system.
“The Social Health Authority (SHA) urges all members to carefully review their hospital bills and visit details each time they receive healthcare services at a SHA-contracted Healthcare facility,” read the statement in part.
Mwangangi noted that once a visit has been lodged in the SHA system, patients will receive a confirmation message on their phone numbers.
The SHA CEO said members of the public should review the details of the message to confirm accuracy before leaving the medical facilities.
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“You will receive a confirmation message on your SHA-registered phone number once your visit has been started in the system. Kindly review the details in the message to confirm accuracy,” she stated.
Mwangangi said the move is aimed at ensuring members do not incur any additional costs arising from delays or errors in visit entry or billing.
Further, she noted that for procedures requiring preauthorization, Kenyans should ensure approval is obtained beforehand, except in emergency cases.
This comes weeks after the SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC) handed over 1188 files of health facilities linked to healthcare fraud to the Directorate of Criminal Investigations (DCI) for investigations.
According to KMPDC, the schemes under investigation include inflating medical bills by converting outpatient visits into inpatient admissions, falsifying records, billing for procedures never carried out, and submitting claims for nonexistent patients.
"This action targets fraudulent and non-compliant healthcare facilities and individuals, marking a critical milestone in the ongoing effort to protect public funds and safeguard the integrity of Kenya's healthcare system," Health CS Aden Duale stated.
On August 26, SHA suspended 45 health facilities from providing services under the Social Health Insurance program.
The suspended facilities span multiple counties, including Mandera, Kisii, Kisumu, Turkana, Kakamega, Homa Bay, Meru, Migori, and Kirinyaga counties.
