Private hospitals issue 14-day notice to SHA over unpaid claims
Private hospitals issue 14-day notice to SHA over unpaid claims
Private hospitals have issued a 14-day go-slow notice to the Social Health Authority and the Ministry of Health over what they describe as unpaid claims amounting to Sh76 billion under SHA and the defunct NHIF.
Through their umbrella body, the Rural and Urban Private Hospitals Association of Kenya (RHUPHA-Kenya), the facilities indicated that hospitals are owed Sh33 billion under NHIF and Sh43 billion under SHA.
According to RHUPHA, the bulk of NHIF debts are linked to public and mission hospitals, including Sh15.2 billion concerning 83 major facilities. The remainder is spread across 2,600 smaller hospitals.
The association noted that among the 83 are 23 public institutions which, it said, account for 10 per cent of the NHIF debt.
RHUPHA has given SHA 14 days to clear NHIF liabilities in line with a presidential directive issued on March 5.
It is also calling for the settlement of at least 50 per cent of the Sh43 billion under SHA and the creation of a clarification mechanism on the SHA portal to allow resubmission of valid but earlier rejected claims.
In addition, the group wants a Dispute Resolution Tribunal set up to handle suspensions, downgrades, and investigations into facilities.
It is also urging transparent publication of claims data, including amounts paid, total submitted, approvals, and payout ratios.
“Kenyan hospitals remain in severe financial distress due to delayed and inadequate reimbursements by the Social Health Authority (SHA). In particular, general inpatient and surgical claims have stagnated, with hospitals reporting 10–20 per cent payout ratios in these categories,” the statement read.
The association termed Health CS Aden Duale’s mass rejection of Sh10.6 billion worth of SHA claims as a move that was hurting compliant hospitals.
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RHUPHA further expressed concern over what it described as arbitrary deletions of bed capacities, downgrades of facilities, and suspensions issued without adequate procedure, contrary to the Fair Administrative Action Act.
“Hospitals continue to face blanket rejection of claims without an avenue to submit clarifications or supporting documents. Publish the names of the 24 hospitals you sent to DCI and the monies you seek to recover from them,” RHUPHA said.
The association also proposed a review of SHA’s financing model, observing that the authority is grappling with a monthly deficit of between Sh2.7 billion and Sh3.5 billion.
SHA collects about Sh5.4 billion per month but receives claims worth Sh8.7 billion.
“As of end August 2025, healthcare providers had submitted Sh96.2 billion in claims. SHA has only paid Sh53 billion, leaving an outstanding obligation of Sh43 billion. The ‘Register Now’ drive without a matching ‘Contribute Today’ campaign has been a policy misstep. Hospitals are being flooded by patients while facilities lack medicines, staff, and operating cash flow,” the association said.
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