The Social Health Authority (SHA) has reported collecting Sh70 billion from contributors since its launch, surpassing the defunct National Health Insurance Fund (NHIF), which only managed Sh45 billion during its entire existence.
SHA Chief Executive Officer Mercy Mwangangi, speaking in an interview on Citizen TV, detailed the inflows, saying Sh8 billion had gone into primary health care, Sh5.9 billion into the emergency and chronic illness fund, Sh54 billion into the Social Health Insurance Fund (SHIF), Sh4 billion from public servants, and Sh500 million from indigenous sources.
Together, she noted, this had averaged Sh70 billion.
Mwangangi also disclosed that the authority had rejected fraudulent claims amounting to Sh10.7 billion out of Sh80 billion submitted by hospitals and clinics across the country. She explained that SHA is still scrutinizing the remaining claims to expose facilities attempting to benefit unlawfully.
“Our law is very clear. If you submit a fraudulent claim to SHA, there are contractual terms that govern what SHA would do, including fines and criminal prosecution,” she said on Tuesday.
She added that the authority had forwarded to the Directorate of Criminal Investigations (DCI) a list of 1,118 health facilities suspected of engaging in fraud.
Of these, 85 were confirmed to have deliberately engaged in fraudulent activities, while another 151 were found to have made false claims and operated outside their licensed care tiers.
Addressing concerns about privacy of patient information during the investigations, Mwangangi emphasized that SHA’s processes comply with the law, assuring that consent is always obtained when patients visit hospitals and fill claim forms.
"The data that the DCI will have is governed by the data protection in our Act and Digital Health Act (DHA) that protects patient data. It's within the law," she said.
"There's no way we will know if the claim is legitimate if we can't access the claim and determine it took place, how would SHA pay, on trust? We can't."
On registration, Mwangangi confirmed that 26 million Kenyans are now enrolled with SHA. Out of these, 890,000 are contributors from the informal sector while 4 million are salaried contributors, making the total number of active payers 4.8 million.
