The Ministry of Health has uncovered a trend of fraud among healthcare facilities under the Social Health Insurance (SHA) program.
In a statement issued on August 25, Health CS Aden Duale noted that audits revealed that some hospitals and clinics have been inflating bills, falsifying records and submitting claims for services never provided.
According to Duale, investigators found that certain facilities were engaging in upcoding, where patients were billed for more expensive procedures than those actually performed.
Health CS discloses 4 ways rogue hospitals are defrauding SHA. Photo: Courtesy.
Other institutions were involved in the falsification of records, altering or creating false medical documentation in direct violation of the Social Health Insurance Act and its regulations.
There were moreover cases where outpatient visits were illegally converted to inpatient admissions, allowing facilities to claim higher reimbursements, and incidents of phantom billing, where services were billed for patients who did not exist.
The health boss cited Nabuala Hospital in Bungoma for filing repeated Caesarean claims for one patient and unsupported maternity claims.
Kotiende Medical Centre in Homa Bay faked clinical records, with one person signing for both day and night shifts.
Vebeneza Medical Centre in Nairobi turned outpatient visits into inpatient claims and admitted its own staff under dubious cases.
Jambo Jipya Hospital in Mtwapa and New Manyalo Nursing Home in Wajir filed false delivery claims and admitted patients beyond capacity.
In Mandera, several facilities colluded to file over 300 duplicate claims for patients admitted on the same dates in different hospitals.
