The Social Health Authority (SHA) has dismissed reports alleging that a private company is handling or benefiting from billions of shillings meant for Taifa Care, insisting that all payments to hospitals are processed directly by the authority in accordance with the law.
In a joint statement issued on Tuesday, July 7, alongside the Digital Health Agency (DHA), the two institutions sought to reassure healthcare providers and the public that no private company has access to or controls funds allocated for hospital claims.
The clarification follows a media report that suggested a private firm was pocketing money through the digital claims system used under the Taifa Care programme.
SHA said the report had created a misleading impression about how the system operates.
“Issues on healthcare financing and claims processing are important to Kenyans, and both institutions welcome public interest in how the system works. Contrary to the impression created by the headline ‘Private firm pocketing SHA billions,’ no private company receives, controls or pays out funds meant for hospitals on behalf of SHA,” the statement said.
According to the authority, the responsibility for receiving, assessing, approving and paying legitimate hospital claims lies entirely with SHA under the provisions of the Social Health Insurance Act, 2023.
The Digital Health Agency, on the other hand, said its role is limited to providing the technology that allows hospitals to submit claims electronically and securely. It does not handle or distribute any of the funds.
SHA also explained that the Taifa Care digital platform was developed through a government procurement process involving a consortium, noting that the engagement of specialised subcontractors is permitted under existing procurement laws.
The authority further addressed questions surrounding the 2 per cent transaction fee referenced in the report, saying the charge is not a payment to manage hospital funds but a service fee provided for under the Digital Health Act, 2023.
According to SHA, the fee supports the digital infrastructure that enables electronic claims processing, verification of patients and healthcare providers, and the secure exchange of health information between health facilities.
It added that the fee is only deducted after a hospital claim has been approved for payment and is processed automatically through the digital system.
The clarification comes as SHA continues settling outstanding claims owed to healthcare facilities across the country. The authority recently announced that it had cleared about 80 per cent of pending payments owed to county health facilities.
At the same time, SHA urged hospitals and other healthcare providers to submit complete claim documents, secure the necessary pre-authorisations where required and ensure their facility and banking details are up to date to avoid delays in payment processing.
