Mercy Mwangangi explains why SHA declined 80% of hospitals’ claims
By David Nthua, September 17, 2025Social Health Authority (SHA) Chief Executive Officer Mercy Mwangangi has revealed that the authority has rejected nearly 80 per cent of claims filed under the Emergency and Chronic Illness Fund.
Speaking to a local TV station on Tuesday, September 16, 2025, Mwangangi placed the blame on some hospitals, saying they had been filing claims that do not exist under the SHA Act.
She said many providers were trying to push in services that are outside the benefits package.
This comes after the government has suspended 45 health facilities across the country from accessing benefits under the SHA.
Dubious claims
According to Mwangangi, the pilot exercise conducted earlier in the year showed glaring gaps.
“We did a pilot exercise on the emergency and chronic illness fund. We allowed the portal to collect the four-month data and then analysed it. We rejected 80% of the claims made by the level 6 and 5 hospitals. These were public facilities. Providers were launching claims for lab tests, which aren’t part of our benefits,” Mwangangi said.
“Providers were launching claims such as cardiac pulmonary arrest, which means death. That is not in our benefits package.”
She added that the authority had noticed a trend where certain facilities repeatedly attempted to slip in non-benefit services, something she termed as fraudulent and unfair to taxpayers who fund the scheme.
It is worth noting that the government launched a biometric identification system to crack down fraud.
User problems and training
The SHA boss insisted that the system itself is functioning well, but providers are struggling to adjust.
“The SHA system is okay; the challenge we have is a user problem. Our providers are having difficulties in embracing the system, and some have even requested capacity training; we have heard those cries,” she said.
Since the introduction of SHA last year, the authority has faced pushback from a section of Kenyans who argue that many claims are unfairly delayed or rejected.
Mwangangi, however, maintained that the rejections are mainly due to misfiled or exaggerated claims.
Her remarks come at a time when frustration is growing among both patients and health facilities, many of whom say that SHA has slowed down access to critical funds.
For Mwangangi, the solution lies in strengthening training for health providers to ensure they understand what is covered, and to weed out any facilities keen on exploiting loopholes.