The Rural and Urban Private Hospitals Association of Kenya (RUPHA) has raised serious concern over what it describes as a disturbing failure in the Social Health Authority (SHA) system.
According to the lobby group, several hospitals that had earlier been suspended for fraud investigations and compliance breaches have mysteriously regained access to the SHA portal.
In a statement issued on Thursday, RUPHA claimed that the facilities — which had been blacklisted due to questionable dealings — were quietly reinstated in the last 24 hours.
Officials from the association linked the development to a “system bug” within SHA’s digital platform.
“Over the past 24 hours, all health facilities that had been suspended from the SHA portal because of ongoing fraud investigations or compliance issues have found their access restored due to a bug affecting the system,” the statement read.
Dr. Brian Lishenga, representing RUPHA, warned that allowing such facilities back into the portal without thorough vetting was dangerous. He noted that it could not only expose unsuspecting patients to unregulated medical services but also weaken ongoing efforts to root out corruption and fraud within the healthcare sector.
SHA Yet to Respond
By the time of publishing, the SHA had not given an official response to the claims. Attempts to get clarification were unsuccessful, with a representative saying they needed more time to investigate the matter.
This controversy comes only weeks after Kenyans expressed outrage over reports that certain health facilities fraudulently claimed funds from SHA while pretending to deliver services.
A Sector Under Scrutiny
The SHA is already under the spotlight as it struggles with its transition from the now-defunct National Health Insurance Fund (NHIF). Hospitals and patients have raised multiple complaints, including delayed reimbursements, exaggerated claims by hospitals, and difficulty accessing services.
In August, the Ministry of Health admitted that fraudulent practices were a global challenge, noting that up to 15% of all health expenditures worldwide are lost to fraud.
Health Cabinet Secretary Aden Duale revealed that an aggressive crackdown had already led to the closure of 728 facilities that were found non-compliant, while another 301 hospitals were downgraded by the Kenya Medical Practitioners and Dentists Council (KMPDC).
Investigations, according to Duale, uncovered disturbing schemes such as upcoding (charging for more expensive services than provided), falsifying medical records, converting outpatient visits into inpatient admissions, and billing for “ghost” patients who never existed.
Earlier in June, SHA had also suspended 40 hospitals after forensic audits revealed irregularities. The authority further announced plans to de-gazette 45 more facilities flagged for fraudulent activity.
With the latest concerns raised by RUPHA, pressure is mounting on SHA to prove that its systems are secure, transparent, and capable of protecting both public funds and patients who depend on them.
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