Adrian Oluoch, LL.B

One financial year into SHA/SHIF and 𝐊𝐬𝐡. 𝟓𝟎 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 has already been lost yet CS Duale and CEO Mwangangi have refused to admit that the funds are lost. Patient Claim Records show a single mother delivering between 2 to 10 babies in the same year at different times. ( Miracle Mothers) This incident occurred 6,392 times in a year and SHA, even with the “NEW” Claims Management System, went ahead and paid 𝐊𝐬𝐡. 𝟏𝟒𝟖 𝐌𝐢𝐥𝐥𝐢𝐨𝐧 Records show one patient going for an open heart surgery 4 times in a day but under SHIF, billing is only limited to once per year. These repeated surgical billing occurred 3,235 times and SHA paid a total of 𝐊𝐬𝐡. 𝟒𝟒𝟓 𝐌𝐢𝐥𝐥𝐢𝐨𝐧. SHIF or SHA (whatever) paid 𝐊𝐬𝐡. 𝟏.𝟓 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 to 137 Medical facilities which submitted claims but they are not contracted by SHA and have no valid agreement with SHA. ( If you go to these hospitals and seek medical services they will tell you “we don’t use SHA” but they still submit claims to SHA and get paid ) 1,091 facilities were paid 𝐊𝐬𝐡. 𝟕.𝟑 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 for medical services not authorized under SHA. ( E.g Cosmetic procedures, certain fertility treatments or highly specialized procedures) 𝐊𝐬𝐡. 𝟒.𝟖 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 and 𝐊𝐬𝐡.𝟏.𝟒 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 were paid to unapproved service codes that were not gazetted or multiple service code lumped up into one entry ( Simply put, Money was paid out for services that either did not officially exist in the system or were recorded in a way that hides what was actually paid for.) NHIF cease to exist but SHIF transferred over 𝐊𝐬𝐡. 𝟏.𝟑 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 to old NHIF operating bank accounts ( the moneys have been withdrawn) 𝐊𝐬𝐡. 𝟐𝟔.𝟖 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 was paid to hospitals without supporting documents for services claimed to have been provided. (They would pay for claims without crucial documents of what or Who is being treated) There is untraced transfer of money from SHIF to SHA. SHIF, the insurance fund, reported transferring 𝐊𝐬𝐡. 𝟕.𝟑 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 to SHA, the Health Authority, but SHA only received 𝐊𝐬𝐡. 𝟑.𝟗 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 leaving 𝐊𝐬𝐡. 𝟑.𝟑 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 unaccounted for. CS Adan Duale appeared to deflect attention by selectively listing certain “Muslim” names, seemingly to suggest that the fraud originated from the hospital rather than from systemic weaknesses within the SHA system itself. The more pressing question, however, is this: wasn’t the justification for procuring a new system at a staggering cost of 𝐊𝐬𝐡. 𝟏𝟎𝟎 𝐁𝐢𝐥𝐥𝐢𝐨𝐧 meant to establish a robust Claims Management System capable of detecting fraudulent billing patterns, unsupported claims, and irregular payments ????? UDA bloggers wants the public to register for SHA, access a basic medical service that is already funded, and then present that as evidence that the system is functioning, and then they force you to turn a blind eye to the systemic fraud that is siphoning billions from the health sector.

Just finished watching the LSK Presidential debate. IMO, Mr. Wanyama is charismatic and funny with a strong political voice. Mr. Kanjama is articulate and formal, while Mr. Kabata provides very strong references in his responses 💪🏾. May the best win this Thursday!