The Social Health Authority (SHA) has announced progress in the implementation of tariffs under the Public Officers Medical Scheme Fund (POMSF) following the conclusion of negotiations with hospitals.
In a statement on Sunday, April 12, SHA CEO Mercy Mwangangi confirmed that discussions with Level 5 and Level 6 facilities have been successfully completed, paving the way for the next phase of the rollout targeting lower-tier hospitals.
“As a result, SHA has commenced the required market analysis and tariff negotiations under POMSF. So far, negotiations with Level 5 and Level 6 facilities have been completed, and the next phase will focus on Level 4 and Level 3 facilities,” the statement read.
SHA outlined how the approved tariffs will be introduced into the system, emphasizing a phased approach that aligns with hospital levels and service packages.
“The approved POMSF tariffs will be implemented progressively in the SHA claims system by hospital level and package, and shall apply to service access, claims submission, adjudication, and reimbursement under POMSF,” the statement added.
SHA reassured that facilities which have already agreed to the negotiated terms will continue offering services to beneficiaries without disruption, under the newly established framework.
“Facilities that have accepted the negotiated tariffs will continue providing services to POMS beneficiaries in line with the approved benefit package and agreed reimbursement terms,” the statement further read.
This comes a week after SHA suspended 12 hospitals over fraudulent claims.
Speaking on Saturday, April 4, in Garissa County, Health Cabinet Secretary Aden Duale said the health facilities were suspended after they were flagged by forensic auditors.
The Health CS emphasized that he will protect resources meant for the treatment of Kenyans under the SHA scheme.
The suspended facilities include: Bungoma West Hospital, Baypharm Medical Center, Dawida Annex Hospital, Kerugoya Medical Center, and Raycos Health Center.
Others are Calvary Hope Medical center, Shamberere Dispensary, Kurafa Medical center, Umoja Three Medical center, and Pro Elite Westlands and Specialist Hospital.
Further, Duale warned that political interference will not stop the crackdown on health facilities involved in fraudulent SHA claims.
He pointed out that 24 facilities are undergoing a forensic audit over suspected fraudulent claims.
“I want to tell the owners of these facilities that political parties will not help you, and so far, we have 24 facilities undergoing a forensic audit. We have a duty, the men and women I work with at the Ministry of Health have firm instructions under the law to protect public resources,” he added.
