Robbing the sick in Kenya

This is a pervasive, systemic fraud affecting county officials in Kenya who hold health insurance policies intended to cover their healthcare costs. Despite paying premiums and issuing insurance cards, many county officials are unable to access treatment because their insurance coverage is inactive or rejected by hospitals. This has resulted in county officials being forced to pay for medical care out of their own pockets or forgoing necessary treatment. These problems are rooted in irregular procurement, corruption, and collusion between county officials, insurance providers, brokers, and some private hospitals. This results in millions of public funds disappearing without providing any real medical protection. The key issues affect county officials, such as Abdulahi in Isiolo, who hold insurance cards for private and public health insurance but are rejected by hospitals, leaving families to pay high medical bills directly. Insurance premiums are deducted and paid by the districts, but benefits are often suspended or coverage is inactive for most employees, with the exception of a few senior managers. Corrupt brokers and insurance companies collude with district officials to collect premiums, while employees suffer without health insurance coverage. An investigation revealed that millions of shillings were paid without appropriate access to healthcare. This scandal was concealed because the lack of health insurance leaves no visible infrastructure. Several districts have experienced this; examples include Bungoma, Kilifi, Meru, Baringo, Nyamira, and Vihiga, where insurance policies are ineffective despite payments. Legal experts confirm that insurers are obligated to provide benefits once premiums are paid. Regulators are under scrutiny for failing to prevent this exploitation. Hospitals are also owed billions in unpaid claims from the health department, further increasing the strain on the healthcare system. This fraud has had tragic consequences; Some district employees died after being denied treatment due to inactive insurance policies. The scandal also triggered political backlash, calling for greater oversight and accountability in the administration of district health funds. It can be seen that millions of shillings paid for district employees' health insurance are lost due to corruption and irregularities, leaving sick district employees uninsured and abandoned despite paying their premiums. The Social Health Authority (SHA) is involved in a context related to insurance fraud, specifically in Kenya's health insurance sector. The Ministry of Health, alongside SHA, has uncovered widespread fraudulent claims involving upcoding, falsification of records, fake inpatient billing, multiple billing, and using ghost patients by various health facilities and professionals. SHA has suspended access rights and billing privileges for these implicated facilities and health workers as part of the crackdown on insurance fraud targeting the public health insurance scheme under SHA. The government has taken strong actions including suspensions, surcharges to recover fraudulent payments, and forwarding cases to criminal investigations and professional disciplinary councils to tackle and prevent further fraud. The Kenyan government is actively involved in the fight against insurance fraud rather than becoming complicit in it. Numerous cases of insurance fraud have occurred in Kenya, including fraudulent claims, fraudulent billing, and collusion between patients, doctors, and healthcare facilities. In response, government agencies such as the Social Health Authority (SHA), the Ethics and Anti-Corruption Commission (EACC), and the Directorate of Criminal Investigations (DCI) investigate and prosecute fraud cases related to health insurance and public transport insurance. For example, the government recently closed 31 hospitals due to fraudulent claims under the SHA and suspended 40 healthcare facilities for fraud violations. Health Minister Aden Duale announced a crackdown on fraud with legal consequences for perpetrators, including the recovery of stolen funds. There is no credible evidence that the government itself is involved in insurance fraud. Rather, it is committed to curbing and punishing such criminal activities in the sector. @https://eastleighvoice.co.ke/sha/172262/from-nhif-to-sha-kenya-s-struggle-to-overcome-health-insurance-fraud-boost-affordability @https://repository.dkut.ac.ke:8080/xmlui/handle/123456789/658 @https://ntvkenya.co.ke/news/govt-shuts-down-31-hospitals-over-fraudulent-sha-claims/ @https://www.dci.go.ke/investigation-bureau @https://www.standardmedia.co.ke/article/2001527122/robbing-the-sick-county-staff-left-to-die-as-policy-millions-vanish @https://www.youtube.com/watch%3Fv%3D9YJFoMg_hWo @https://www.youtube.com/watch%3Fv%3DIg4sNnhX9mc @https://www.youtube.com/watch%3Fv%3DIg4sNnhX9mc @https://www.youtube.com/watch%3Fv%3D9YJFoMg_hWo