The Social Health Authority has moved to suspend Bungoma West Hospital from its network for three months following allegations of improper billing practices linked to claims that are under investigation.
In a formal notice dated March 30, 2026, SHA Chief Executive Officer Dr Mercy Mwangangi said early findings point to violations involving questionable claims submitted by the facility, including allegations of charging for services that were not actually delivered.
"Following reports of suspected fraudulent claims practices at Bungoma West Hospital, including submitting claims for unperformed services, from our preliminary investigations, SHA has identified breaches of GCC Clause 16," Mwangangi wrote in the suspension communication.
The directive, which took effect immediately, prevents the hospital from admitting beneficiaries under SHA, submitting claims, requesting approvals in advance, processing notifications, or receiving any form of payment from the authority during the suspension period.
SHA indicated that it will not be responsible for any services offered by the hospital during the suspension unless there is prior written approval from the authority.
"Therefore, in accordance with GCC Clause 16.2, Bungoma West Hospital is hereby suspended from providing healthcare services to SHA beneficiaries and transacting with SHA, effective immediately for a period of ninety (90) days pending completion of investigations," stated Mwangangi.
"Your facility shall not admit SHA beneficiaries, process notifications, request pre-authorisations, submit claims, or receive payments. SHA is not liable for services rendered during this stoppage without express approval."
The authority has directed the hospital to ensure continuity of care for affected patients by transferring all SHA beneficiaries to nearby contracted facilities, working in coordination with the local SHA office in Bungoma. The hospital is also required to inform patients of the suspension and cooperate fully with ongoing inquiries.
Copies of the suspension notice were shared with the Kenya Medical Practitioners and Dentists Council and the Digital Health Authority to support further regulatory follow-up and accountability measures.
SHA said its preliminary assessment flagged suspected false claims as the main concern, pointing to instances where services were allegedly billed but not provided.
The action comes at a time when several private hospitals across the country are reassessing their engagement with SHA, with some notifying patients that they are pausing insurance-based services due to unresolved operational matters.
In some facilities, management notices have directed patients to seek alternative providers while indicating that services will still be available on a cash basis or under other insurance arrangements.
One such notice stated: "All staff are directed to continue offering services to all clients except SHA clients, unless on a cash basis at our main hospital."
These developments reflect growing strain between healthcare providers and the national insurer, with concerns raised around delayed reimbursements and administrative challenges affecting service delivery across the sector.
Aden Duale, the Health Cabinet Secretary, has previously warned that facilities found engaging in fraudulent claims risk swift action, including suspension and further regulatory sanctions as the government steps up oversight of the system.