KENYA: Dozens Of Hospitals Under Investigation For Fraudulent Sovial Health Authority Claims

     By Lisbeth Micheni, Kenya 

A recent investigation has unveiled a significant scandal involving numerous healthcare providers, primarily Level 4 and Level 5 hospitals, linked to fraudulent claims submitted to the Social Health.

Report highlights an organized scheme where outpatient visits have been falsely reported as inpatient admissions, unnecessary patient admissions have occurred, and in some instances, fictitious patients have been documented within overcrowded facilities.

These hospitals are reported to have misappropriated approximately Ksh.100 million from government funds.

Three whistle-blowers have stepped forward, providing testimony to the Ministry of Health about the coercion faced by some healthcare workers to engage in deceitful acts, which include the unauthorized sharing of pre-authorization codes to facilitate fraud.

Moreover, patients are implicated in this misconduct, with some individuals reportedly sharing their personal hospital codes to manipulate claim amounts.

Health Cabinet Secretary Aden Duale has taken notice of this illegal activity.

During a statement made in Kisumu County, CS Duale expressed the government’s zero-tolerance approach towards health facilities that misuse resources meant for the SHA. He announced the suspension of operations at numerous facilities across more than ten counties and indicated that actions are being taken against those involved, including the potential withdrawal of licenses by the Kenya Medical Practitioners and Dentists Council.