Health Cabinet Secretary Aden Duale has revealed that the Social Health Authority (SHA) has rejected claims worth Ksh.10.6 billion due to fraudulent activities, as the government escalates its campaign against corruption in the healthcare sector.
Speaking at Afya House on Monday, Duale defended the rigorous review process, stating it’s a “necessity, not an option” to protect public funds.
He noted that an additional Ksh.3 billion in claims are being re-evaluated for missing documents, with a further Ksh.2.1 billion under surveillance for suspected fraud.
Duale’s statement comes amid a growing public outcry over allegations of corruption within the new health insurer.
However, the CS clarified that the crackdown is a proactive measure to secure a robust and corruption-proof system.
Citing Section 48(5) of the Social Health Insurance Act, 2023, he emphasized that the law provides for penalties against providers who knowingly falsify information to defraud the authority.
The Ministry’s intensified war against fraud, which began in April 2025 under the TaifaCare digital claims system, has exposed a litany of deceptive practices.
These include upcoding (billing for a more expensive procedure than the one performed), falsification of medical records, phantom billing for non-existent patients, and the illegal conversion of outpatient visits into expensive inpatient claims.
Duale provided specific examples of the malpractice uncovered during forensic audits. Nabuala Hospital in Bungoma was flagged for allegedly submitting falsified maternity claims, including multiple caesarean sections on the same patient within days.
Similarly, Kotiende Medical Centre in Homa Bay is accused of using fabricated documents signed by a single individual for both day and night shifts. Other facilities in Nairobi, Mtwapa, and Mandera were implicated in similar schemes.
The crackdown has led to decisive regulatory action against errant facilities. So far, 728 non-compliant health facilities have been shut down, with another 301 downgraded by the Kenya Medical Practitioners and Dentists Council (KMPDC).
Furthermore, SHA has suspended 40 facilities and is in the process of degazetting an additional 45 that have been flagged for fraudulent activities.
“To all healthcare providers: consider this a final warning,” Duale cautioned. “We are watching. Any facility, doctor, or patient found to be involved in fraudulent activities will be held liable and face the full force of the law.” He stressed that the government will pursue prosecution and permanent removal of fraudulent providers from the SHA system.
The ministry has already begun recovering wrongfully paid funds in collaboration with law enforcement agencies. Members of the public are urged to report any suspicious activity through the SHA toll-free line 147.
On the issue of pending claims from the defunct National Hospital Insurance Fund (NHIF), Duale assured the public that all verified claims of up to Ksh.10 million will be paid through a supplementary budget.
He added that larger claims will undergo fresh audits before disbursement, reaffirming the government’s commitment to pay only for legitimately rendered services.
The CS noted that out of Ksh.82.7 billion in claims submitted under the Social Health Insurance Fund (SHIF), Ksh.53 billion has been paid, with an additional Ksh.6.4 billion approved and awaiting disbursement.
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