DHA CEO defends 2% service charge on SHA claims

The Digital Health Agency (DHA) has defended the two per cent service charge deducted from claims processed through the Social Health Authority (SHA), insisting that the fee is a legitimate charge for services offered to healthcare facilities.

The defence comes amid a legal challenge seeking to suspend the two per cent utilisation fee, with petitioners questioning its legal basis and the manner in which it was introduced.

According to the DHA Chief Executive Officer, Anthony Lenaiyara, the money deducted from SHA claims is not paid to a private entity but to the agency for the digital services provided in processing claims.

“SHA is not paying the 2% service charge to a private entity; it's being paid to DHA, and it's a service charge,” the CEO said.

He further noted that the charge is meant to support efficiency in the processing of healthcare claims, including reducing the costs associated with paperwork and printing that was used before in these facilities.

“We offer efficiency to reduce the paperwork and workload in our facilities, and that's what is being paid for, and it's paid by the user, who is the facility. They are paying for efficiency to process their claims and offer a service,” the CEO said.

The comments come after a petition was filed at the High Court seeking to suspend the two per cent utilisation fee deducted from SHA claims.

The petitioners raised questions over the legality of the charge, arguing that the deduction lacks a sufficient legal basis while challenging the process through which the fee was introduced and questioning how the money collected through the deductions is managed.

The legal challenge has further brought scrutiny to the financial implications of the fee, particularly given the billions of shillings in claims processed under SHA.

However, the DHA CEO maintains that the two per cent figure was not arrived at arbitrarily.

“We didn't just land on that figure, we did public participation, asked parliament and agreed on that 2%, which is capped at five thousand shillings,” the CEO said.

According to Lenaiyara, the law doesn’t allow the Agency to charge more than the five thousand fee, no matter the facilities bills, maintaining that healthcare facilities are effectively paying for a service that enables them to process claims digitally, rather than making an unexplained payment to a private company.

As the legal challenge proceeds, the court is expected to consider the questions raised by the petitioners while the DHA continues to defend the charge as a legitimate service fee.

However, for healthcare providers, the outcome of the case could have a direct bearing on the amount they receive from claims processed through the SHA system and the cost of accessing digital claims-processing services