The Social Health Authority (SHA) has launched a nationwide training programme to help hospitals and clinics clean up their medical claims and cut down on fraud.
The virtual sessions, dubbed “Provider Clinics,” kicked off on Wednesday, August 27, and will run until September 1. The training will walk facilities through the claims process, why some are approved or rejected, and what kind of records are needed.
Level Four facilities from all counties are scheduled for training on Thursday, with Level Three on Friday, while Level Two facilities will take part on Monday.
The move comes after an audit of claims filed under the Social Health Insurance Fund (SHIF) and Primary Health Care (PHC).
SHA Chief Executive Officer, Dr Mercy Mwangangi, said health facilities have so far submitted claims worth Ksh91.7 billion.
Out of this, Ksh60.7 billion has been paid, Ksh6.4 billion approved and pending payment, while claims worth Ksh10.6 billion were thrown out for fraud or non-compliance.
Some of the rejected claims involved exaggerated billing, ghost patients, or unnecessary treatment. Another Ksh3 billion is being re-checked because of missing documents, while Ksh2.1 billion has been flagged for follow-up investigations.
“Training is important so facilities know exactly what is expected and can avoid mistakes or fraud that lead to rejections and delays,” Dr Mwangangi said in a statement.
