SHA has collected Ksh.70B, rejected Ksh.10.7B in claims - CEO Mwangangi

Speaking during an interview on Citizen TV, Mwangangi broke down the inflows as Ksh.8 billion for primary health care, Ksh.5.9 billion for the emergency and chronic illness fund, Ksh.54 billion for the Social Health Insurance Fund (SHIF), Ksh.4 billion from public servants, and Ksh.500 million from indigenous sources, totaling to an average of Ksh.70 billion.

She also revealed that the authority had already rejected fraudulent claims amounting to Ksh.10.7 billion out of Ksh.80 billion in claims submitted by facilities countrywide. 

Mwangangi noted that the Authority was still reviewing the claims submitted to unearth fraudulent facilities. 

“Our law is very clear. If you submit a fraudulent claim to SHA, there are contractual terms that govern what SHA would do, including fines and criminal prosecution,” she said.

According to Mwangangi, SHA had submitted to the Directorate of Criminal Investigations (DCI) a list of 1,118 health facilities suspected of fraud. 

Out of these, 85 were found to have blatantly engaged in fraudulent activities, while 151 were flagged for submitting fraudulent claims and operating outside their licensed tiers of care.

On privacy concerns of patients' data during the review, the CEO emphasized that SHA’s handling of patient data was lawful, adding that patient consent is obtained when they visit facilities and fill out claim forms.

"The data that the DCI will have is governed by the data protection in our Act and Digital Health Act (DHA) that protects patient data. It's within the law," she noted.

"There's no way we will know if the claim is legitimate if we can't access the claim and determine it took place, how would SHA pay, on trust? We can't."

On registration, Mwangangi confirmed that 26 million Kenyans have so far signed up for SHA, with 890,000 contributors from the informal sector and 4 million salaried contributors, bringing the total number of active payers to 4.8 million.