Following the tensions between the Social Health Authority (SHA) and healthcare providers, which have crippled services across private facilities for a section of government employees seeking treatment, the authority has announced a raft of changes to address the claims, including the involvement of investigative agencies.
In a statement shared on Wednesday by State House Spokesperson Hussein Mohamed and State House Economic Council advisor Moses Kuria, SHA revealed that it had discovered some facilities were submitting claims that were not genuine.
In response to this, the authority announced that it had alerted investigative agencies to conduct an audit of the claims.
''Regarding the old debts owed to Facilities by the defunct NHIF, whereas some of the claims are genuine, it has come to the attention of the relevant authorities that some claims were pushed through as we came close to the transition to SHA in order to create liabilities,'' a statement from SHA read in part.
''The investigative agencies are seized of the matter and soon the wheat will be separated from the chaff and necessary action will be taken,'' it added.
The announcements came just a few days after the Rural and Urban Private Hospitals Association of Kenya (RUPHA) announced on Thursday, February 20, that they would withhold treatment for patients under the SHA starting Monday, February 24.
While making the announcement, the heads of RUPHA also stated that their hospitals would stop treating select civil servants using insurance backed by government institutions starting Monday.
"We will stop providing medical services (to some civil servants) using the government insurance from Monday," announced Rev Joseph Kariuki, Deputy Chairperson of RUPHA.
On Tuesday, SHA Chief Executive Officer Robert Ingasira assured patients that the government was working round the clock to ensure that the stalemate is addressed.
However, the CEO decried the delay in paying some of the health facilities over what he termed as a delay prompted by a challenge on pending bills.
Payment Changes
Meanwhile, SHA has announced changes to the payment system for patients, stating that they will be notified via a short message service (SMS) once hospitals receive payments for the services provided.
"Effective 1st March 2025, patients will receive an SMS once the hospital receives payment for their treatment. There will be no one to mislead," SHA said in a statement.
