Ministry Flags Alarming Cases of Fraud
On Sunday, June 29, Duale condemned increasing malpractice cases, calling them “a betrayal of the trust placed in our health system.” He outlined several schemes under investigation, including:
- Converting outpatient claims into inpatient ones to inflate bills
- Forced admissions without medical justification
- Use of fake patient data and shared access credentials
- Double billing both SHA and patients
Legal Consequences for Violators
“Any facility found engaging in these practices will face immediate closure and prosecution,” Duale stated. He warned that individuals and institutions would be held personally accountable, with the government seeking full legal recourse.
One of the gravest concerns was facilities allegedly demanding payments even after SHA claims had been submitted. Duale confirmed this was happening and urged victims to report via the SHA Call Center (147).
Examples of Offenses
The ministry also highlighted specific issues, including:
- Misuse of Pre-Authorization codes
- Admission of nonexistent patients
- Hospitals exceeding bed capacity to raise claims
Push for Universal Health Coverage
“Fraud against the SHA Fund undermines universal healthcare and hurts every Kenyan,” Duale emphasized. He concluded by reiterating that the crackdown was not temporary and that future audits will continue to expose violations.
“We will not hesitate to take strong and swift action against any individual or institution found culpable. Let this serve as a final warning.”
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