Dozens of hospitals on the spot over fraudulent multi-million-shilling SHA claims

In what now appears to be a recycled script of corruption, dozens of healthcare facilities, mostly Level 4 and Level 5 hospitals, are at the centre of a scandal involving false medical claims to the Social Health Authority (SHA).

An internal report obtained by Citizen TV reveals a well-coordinated network of fraud, with outpatient visits being falsely converted into inpatient claims, patients admitted unnecessarily, and in some cases, ghost patients admitted in facilities already filled to capacity.

The health facilities have allegedly defrauded the government of nearly Ksh.100 million.

Three whistle-blowers have come forward, recording statements with the Ministry of Health and exposing how rogue healthcare workers are being coerced into fraudulent practices, including sharing pre-authorization codes to facilitate the theft.

Patients, too, are complicit in the scam, with some allegedly sharing personal hospital codes to inflate claims, an illegal practice that has now attracted the attention of Health Cabinet Secretary Aden Duale.

“Wanafanya double claims, they have turned outpatient into inpatient. In fact, nimefunga hospitali karibu saba hapa Kisumu. Hii leo asubuhi nimefunga Bungoma, nimefunga Busia, nimefunga Kilifi, nimefunga Mandera, Wajir, Kajiado — hospitali 35. Hatuwezi kubali utumie jina ya Wakenya. Uko na vitanda 14 unasema uko na vitanda 100,” said the health minister.

Speaking in Kisumu County, CS Duale said they will not allow rogue facilities to drain SHA resources.

“If you are a medical worker and you allow your pre-authorization code itumiwe kuibia pesa SHA... Kama wewe ni Mkenya na utumiwe na health facility ili wapore pesa ya SHA — kesho Monday I am sending a number of files of health facilities to DCI,” he said.

According to a source at the Ministry of Health, SHA has already suspended services at some of the facilities in more than 10 counties.

The Kenya Medical Practitioners and Dentists Council is also said to be in the process of withdrawing licenses of the said facilities and practitioners involved.