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Health Cabinet Secretary Aden Duale has put both health practitioners and patients on notice, warning of severe legal consequences for anyone found defrauding the Social Health Authority (SHA) fund.
Speaking in Kisumu on Friday, Duale confirmed that an ongoing crackdown had already forced the closure of 35 health facilities suspected of engaging in fraudulent activities that drain the SHA’s vital resources.
“I am sending a number of files on health facilities to the DCI,” Duale said.
Health Cabinet Secretary Aden Duale
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CS Duale detailed six key areas where perpetrators will face the full weight of the law:
1. Outpatient Claim Scams
Health facilities accused of converting outpatient claims into more expensive inpatient claims in order to inflate reimbursements will face immediate closure, Duale warned.
The CS emphasised that such practices distort medical reporting and place unnecessary strain on the health financing system.
2. Forced Admissions
Duale also put on notice health workers colluding with facilities to admit patients who do not need to be hospitalised.
He warned that both the health workers and the facilities engaging in forced admissions would be held personally responsible for any resulting fraud, describing these acts as a betrayal of the medical profession’s ethics.
Social Health Authority (SHA) headquarters in Nairobi
3. Code Sharing
The Cabinet Secretary noted growing concern over patients sharing their SHA service codes with facilities to claim more services than they have actually received.
Duale announced that any patient found engaging in this malpractice, together with the doctors or health facilities involved, would be prosecuted to protect the sustainability of the SHA fund.
4. Pre-Authorisation Code Abuse
According to Duale, some doctors have been misusing pre-authorisation codes to make fraudulent claims on the SHA fund.
He warned that health workers who compromise their professional integrity by sharing or misusing these codes would be prosecuted without hesitation.
5. Ghost Patient Admissions
The CS revealed that investigations had uncovered cases of facilities admitting “ghost patients”, non-existent individuals, beyond their actual capacity in order to defraud the system.
Such facilities, Duale stated, would be brought to book and subjected to closure as well as legal action.
6. Double Billing
Duale singled out facilities that simultaneously bill patients in cash while also charging the SHA fund for the same services.
He described this as a particularly egregious form of theft that victimises patients and the health system alike. Patients are encouraged to report such incidents through the SHA call centre at 147 so that action can be taken.
The Cabinet Secretary stated that all individuals and facilities already found to have fraudulently benefited from the SHA fund had been flagged and would be handed over to the Directorate of Criminal Investigations (DCI) for thorough investigations before prosecution.
Health Cabinet Secretary Aden Duale
The Social Health Authority (SHA) fund, a cornerstone of Kenya’s push toward universal health coverage, is designed to make quality healthcare affordable and accessible while reducing the burden of out-of-pocket medical payments.
However, officials have warned that unscrupulous practitioners and colluding patients threaten to undermine its mission through fraudulent schemes.
The Ministry of Health is urging members of the public to stay vigilant and report any suspicious activities involving SHA funds through the 147 hotline.
This, the ministry says, will support efforts to safeguard the scheme and ensure that funds reach those who genuinely need medical care.