A Level 5 hospital in Nyeri will have received a total windfall of Ksh400 million from the Social Health Authority (SHA) by the end of this month, Health Cabinet Secretary Aden Duale has revealed.
Speaking before Members of Parliament at the National Assembly on Wednesday, November 5, CS Duale disclosed that the Consolata Hospital Mathari was set to receive Ksh29.3 million in verified claims in the next payment cycle on November 14.
The funds would be in addition to Ksh372 million already received by the health facility since the beginning of SHA, constituting 17,432 claims.
Still, Duale noted that as of October, the hospital had submitted 4,792 claims under review, totalling Ksh81 million.
However, Duale noted that 335 claims totalling Ksh14.7 million filed by the hospital had been rejected by the Ministry of Health. The CS also informed that SHA had returned claims worth Ksh50 million.
Duale gave out the figures in response to a question by Mukuruweini MP John Philip Kaguchia over an alleged debt of Ksh450 million owed to the hospital in unpaid claims.
Consolata Hospital Mathari, situated on Ihururu Road in Nyeri County, serves residents of Kiganjo/Mathari Ward and the larger county, with Nyeri's 2019 census population at over 759,000. The hospital is a key healthcare provider, offering 24-hour emergency services, comprehensive outpatient and inpatient care, and three operating theatres for surgeries.
Its maternity and child health department supports mothers and children with full antenatal and child welfare services.
The facility is equipped with advanced imaging at the Our Lady of Perpetual Help Diagnostic Centre and a modern laboratory. Specialist units include an eight-bed dialysis centre, a cancer care wing for chemotherapy, and a comprehensive care centre for HIV/AIDS patients.
Additional offerings range from ENT, eye, and dental care to physiotherapy, vaccination, and counselling.
The faith-based hospital had lamented about prolonged delays in settling the claims, which were a mixture of the defunct National Health Insurance Fund (NHIF) and the SHA.
Together with other faith-based hospitals, they had raised alarm over the alleged fraudulent payouts to other hospitals while legitimate ones like theirs were missing out, despite still providing services to patients.
Among the reasons contributing to delays in the claims payout, Duale cited ‘high-value complex claims’ submitted by the hospital on services such as oncology, surgery, and dialysis. As per Duale, such claims required extensive claim review as part of the government’s claim adjudication process.
Another reason disclosed by Duale was provider submission issues, where he noted delays in the submission of documents by the service providers. He gave examples of missing signatures, incorrect patient details, and low resubmission rates for correction as some of the factors contributing to the submission issues.
The CS also divulged that claims management issues within SHA due to court cases and litigation contributed to delays, but assured that this would be a thing of the past after the Authority handled the matter.
Back in February, the Archbishop of the Catholic Archdiocese of Nyeri had urged the government to disburse funds owed to faith-based hospitals, warning that delayed reimbursements severely impacted healthcare services in the facilities.
In his appeal, Muheria revealed that Catholic faith-based hospitals nationwide were collectively owed approximately Ksh2.5 billion, significantly hampering their ability to provide quality healthcare.
