The Social Health Authority (SHA) has suspended Bungoma West Hospital for three months over fraud allegations, even as more private hospitals across the country are distancing themselves from the insurer.
Bungoma West Hospital will not handle SHA patients for the next 90 days after the authority raised concerns over how it has been making its claims.
In a letter dated March 30, SHA CEO Dr Mercy Mwangangi said early checks indicated the hospital may have been billing for services not actually provided to patients.
With the suspension now in place, the facility is not allowed to admit SHA patients, submit claims or receive payments from the authority during that period.
SHA also said it will not cover any treatment offered to its members at the hospital unless it approves.
It is required that the facility transfer all the clients who were using the services of SHA to other nearby hospitals within the approval of the scheme. Also, it is important to inform the patients about such a measure and assist in investigating this case further.
Other regulatory bodies, such as the Kenya Medical Practitioners and Dentists Council, have received information about this case. This was done as part of investigation process.
However, as this happens, one might expect that there is a much bigger issue at stake.
There have been cases when a variety of private hospitals from all over Kenya have decided to cut ties with the SHA scheme. They stated that they would not provide health care coverage for patients under such a program until problems with payments are sorted out.
In some cases, patients are required to pay in cash for treatment if they wish to receive it. Other health coverage programs are allowed.
The developments show that healthcare providers are becoming less confident with regard to SHA.