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The Social Health Authority (SHA) has suspended 45 health facilities across 18 counties from accessing benefits.
Chief Executive Officer Mercy Mwangangi announced the suspension in a notice dated Tuesday, August 26, saying the affected facilities will not receive any benefits from the authority during the suspension period.
“The facilities listed in the schedule shall not be entitled to any benefit from the Social Health Authority during the period of their suspension,” said Mwangangi.
The list includes prominent hospitals such as Nyanchwa Adventist Mission Hospital and Lenmek Hospital in Kisii, Northgate Hospital in Garissa, Palmcare Sinai Hospital in Uasin Gishu, and two Equity Afia branches in Homa Bay and Mandera.
Other facilities suspended are spread across Nairobi, Turkana, Busia, Bungoma, Narok, Migori, Nandi, Kirinyaga and Wajir counties. Mandera and Kisii have the highest number of facilities affected.
Health Cabinet Secretary Aden Duale, speaking at a press briefing at Afya House in Nairobi on Monday, said the suspensions followed a digital audit that flagged widespread fraud in the scheme.
“Malpractices uncovered include falsifying records, inflating and phantom billing, upcoding and converting outpatient visits into costly inpatient claims, actions that rob Kenyans of quality care,” noted Duale.
Duale warned that fraudulent providers, facilities and patients will face prosecution and recovery of funds.
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He urged Kenyans to report suspected fraud through SHA’s toll-free line 147. He noted the Ministry of Health is working with leading medical insurers on a Joint Anti-Fraud Action to reinforce accountability and restore trust in the health sector.
The CS further cautioned hospitals and doctors against fraudulent claims, saying offenders will be forced to refund money and face the full force of the law.
“Hospitals like Nairobi Hospital, Aga Khan, Kenyatta National Hospital and Kenyatta University Hospital all hold individual contracts with SHA, not through associations. We are watching closely. Anyone involved in fraud will be held liable,” explained Duale.
The Cabinet secretary noted his office has already begun recovering misused funds and will work with law enforcement agencies to prosecute perpetrators.
“Your participation is vital in protecting our social health insurer and securing a healthier future for our nation,” added Duale.
He revealed the health ministry had earlier suspended 40 other facilities and confirmed that Sh 7.7 billion has been disbursed to Primary Health Care (PHC) as part of government reforms.
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