The Ministry of Health is set to launch a new digital portal under the new Social Health Insurance Fund (SHIF) to tame the increased number of insurance frauds.
The Centralized Healthcare Provider Management System (CHPMS) estimated to cost the government Ksh5 billion will enhance the collection of SHIF monthly contributions from citizens.
Other functions include registration, validation and the processing of medical claims submitted by patients from approved medical institutions.
According to the draft Regulatory Impact Statement for the Social Health Regulations 2023, the ministry noted that the system will help curb false or exaggerated claims by policyholders by 10 to 20 per cent.
In addition, the system which accredited hospitals will use to input patient data and record SHIF claims, will enhance transparency as an audit trail can be retrieved for referencing.
“The system will permit user rights to authorised persons and apply to the board for rights and access to the system in line with the Data Protection Act 2019,” the ministry noted.
SHIF replaced the defunct National Health Insurance Fund (NHIF) which was linked to fraud and corruption-related cases resulting in losses of millions of shillings.
The High Court in November 2023 halted the implementation of the new healthcare plan in a petition filed by businessman Joseph Enock Aura challenging some of its sections.
Court of Appeal on Friday, January 19 lifted the order, pending a ruling in an appeal filed by the State.
“We hereby suspend the orders of the High Court restraining the implementation and or enforcement of The Social Health Insurance Act, 2023, The Primary Health Care Act, 2023,’’ a three-judge bench ruled.
Health Cabinet Secretary (CS) Susan Nakhumicha speaking at a local media house on Wednesday defended the health plan, noting that the system was preventive and promotive, as opposed to NHIF which was curative in nature.
