SHA Pays Karen Hospital KSh202M of KSh303M Claims

The Social Health Authority (SHA) has paid Karen Hospital KSh202 million out of approximately KSh303 million in claims submitted by the facility for medical services provided to patients.

SHA CEO Dr Mercy Mwangangi gave the figures while responding to concerns over delayed reimbursements to hospitals under the SHA system.

Mwangangi said the amount paid represents 66.5 per cent of the total claims submitted by Karen Hospital.

“Karen Hospital has submitted claims worth approximately Ksh303 million. SHA has paid them about Ksh202 million which is 66.5% of the total claims,” Mwangangi said.

She added that SHA had rejected claims worth KSh9.5 million, equivalent to about three per cent of the total claims submitted by the hospital.

“We have rejected claims worth Ksh9.5 million is just 3% of the total claims,” she said.

The figures were presented in response to a question from Dr Juliet Gikonyo, who raised concerns over hospitals that had allegedly not received reimbursement for services already provided to patients.

Dr Gikonyo asked whether Mwangangi was aware that many hospitals had not been reimbursed and sought details on the amount owed by SHA for services already provided.

President William Ruto, who was present during the exchange, urged Dr Gikonyo to provide specific information rather than make broad claims.

“Dr Gikonyo it is good to be truthful. Let’s avoid generalities,” Ruto said.

The exchange highlights the ongoing debate over SHA reimbursements to healthcare providers and concerns over how quickly hospitals receive payments for services rendered to members.

For hospitals, delays in reimbursement can affect cash flow and their ability to purchase medicines, pay suppliers and meet operational costs, while the government has maintained that claims must undergo verification to ensure that only legitimate services are paid for.

The Karen Hospital figures provided by Mwangangi show that while a substantial portion of the facility’s submitted claims has been paid, a balance remains pending alongside claims that have been rejected.

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