The Social Health Authority (SHA) has so far raised Ksh70 billion since it began operations, a figure that already surpasses the Ksh45 billion collected by the now-defunct National Health Insurance Fund (NHIF) during its entire run.
Speaking during an interview on Citizen TV, SHA Chief Executive Officer Mercy Mwangangi explained that the funds were spread across various programs: Ksh8 billion for primary health care, Ksh5.9 billion for emergency and chronic illness, Ksh54 billion for the Social Health Insurance Fund (SHIF), Ksh4 billion from public servants, and Ksh500 million from indigenous sources.
But even as the money comes in, SHA has already uncovered massive fraud. Dr. Mwangangi revealed that out of the Ksh80 billion worth of claims filed by health facilities across the country, Ksh10.7 billion were flagged as fraudulent.
“Our law is very clear. If you submit a fraudulent claim to SHA, there are contractual terms that allow for fines and even criminal prosecution,” she warned.
The authority has since forwarded 1,118 suspicious health facilities to the Directorate of Criminal Investigations (DCI).
Investigations show that 85 facilities were outrightly involved in fraud, while 151 submitted false claims and operated outside their licensed categories of care.
Dr. Mwangangi also reassured Kenyans on privacy concerns, saying patient data is handled strictly within the law and in line with the Data Protection Act and the Digital Health Act.
“There’s no way we can confirm whether a claim is genuine without reviewing the data. SHA cannot just pay on trust,” she said, adding that patients give consent when filling out claim forms.
On registration, she confirmed that 26 million Kenyans have already signed up for SHA.
Of these, about 890,000 are contributors from the informal sector and 4 million are salaried employees, bringing the total number of active contributors to 4.8 million.
