The Social Health Authority has imposed a 90-day suspension on Bungoma West Hospital due to alleged fraudulent billing activities, concurrent with a rising trend of private healthcare facilities nationwide terminating their partnerships with the embattled national health insurance provider.
Through a March 30, 2026 correspondence signed by SHA Chief Executive Officer Dr Mercy Mwangangi, the authority prohibited the Bungoma medical center from attending to SHA members, referencing infractions related to corrupt and deceptive billing methods.
“Based on preliminary investigations following reports of questionable billing practices at Bungoma West Hospital, including claims for services not provided, SHA has determined violations of GCC Clause 16,” Mwangangi stated in the suspension notice obtained by .
The suspension, effective immediately upon the letter’s issuance, prevents the hospital from admitting SHA members, processing notifications, requesting pre-authorizations, submitting claims, or accepting payments from the authority.
SHA clarified it assumes no responsibility for services delivered during the suspension period without its explicit consent.
Per a statement provided to , SHA’s investigation uncovered suspected fabricated claims submitted to the authority as the main violation.
As per the suspension terms, the hospital is required to transfer all current SHA patients to the nearest SHA-affiliated facilities, coordinated via the Bungoma SHA branch, and formally inform all affected members of the service halt.
The authority has also instructed the hospital to fully cooperate with continuing investigative efforts. Copies of the suspension notice were sent to the Kenya Medical Practitioners and Dentists Council and the Digital Health Authority for additional scrutiny.
The suspension coincides with private healthcare providers informing patients of their temporary discontinuation of all SHA insurance services “due to ongoing matters with the insurer”, guiding clients to seek treatment at other SHA-approved facilities in the area.
The hospital’s notice indicates an expanding nationwide trend where healthcare institutions are independently withdrawing from SHA arrangements, citing unsettled payment disagreements, delayed compensations, and administrative challenges with the relatively new insurer.
One medical facility advised patients that all services would moving forward be provided exclusively on a cash payment basis, while acknowledging that other insurance programs would continue to be honored.
“All personnel are instructed to maintain service provision to all patients except SHA members, unless payment is made in cash at our primary hospital,” the institution’s management notice stated.