The Social Health Authority (SHA) has issued a public notice urging all its members to actively review their hospital visit records and billing details after every healthcare service to avoid potential errors and unexpected charges.
Under the banner “Bima Bora, Afya Nyumbani”, SHA has launched “5 Steps to Safer Billing”, a call-to-action encouraging Kenyans to take charge of their health records.
In a statement released by the SHA Chief Executive Officer, Mercy Mwangangi, the public has been advised to ensure that every hospital visit is accurately recorded in the SHA system on the exact date of service.
“We want to empower members to protect themselves from billing errors and ensure they receive the full benefits of their SHA coverage,” said Dr. Mercy Mwangangi
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SHA 5 Billing Rules
According to SHA, members should follow these five key steps:
- Verify Visit Entry: Ensure that your visit is recorded in the SHA system on the actual date of service.
- Check Confirmation Message: A message will be sent to your registered SHA phone number when a visit is logged. Review it for accuracy.
- Review Your Bill: Before leaving the facility, confirm that all services are accurately listed and billed at approved SHA rates.
- No Surprise Costs: Members should not incur out-of-pocket expenses for issues resulting from facility delays or billing errors.
- Confirm Preauthorization: For any procedures that require preapproval, ensure it was obtained except in emergency cases.
Dr. Mwangangi explained that vigilance by members helps maintain the integrity of the national healthcare system.
Any discrepancies or questions should be reported immediately to the healthcare facility or directly to SHA via the toll-free number 147.
“If you notice any discrepancy, immediately contact the facility or call SHA on 147 for assistance,” she said.
Fraud Cases
This comes just a day after seven individuals were arraigned before the Milimani Law Courts for allegedly siphoning over Ksh7 million through falsified medical claims.
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The accused are facing criminal charges, including conspiracy to commit a felony, forgery, falsification of records, obtaining proceeds of crime, cheating, and uttering false documents.
According to court documents and investigations presented by the prosecution, the suspects are alleged to have conspired to manipulate the SHA system by submitting fake medical claims for services that were never rendered to patients.
On September 1, 2025, the Directorate of Criminal Investigations (DCI) received 1,188 case files from both the Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC).
This followed a surge of public complaints regarding suspected fraudulent activities within the healthcare sector.
The submitted documents related to individuals and entities suspected of engaging in healthcare fraud.
These parties are believed to have actively worked to compromise government efforts aimed at delivering quality healthcare services to the public.
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