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| Health Cabinet Secretary Aden Duale |
The government has sounded a stern warning and threatened mass arrests after uncovering an elaborate web of fraud targeting the Social Health Authority (SHA) Fund, implicating hospitals, health workers, and even patients in a widening scandal.
In a statement on Sunday, June 29, Health Cabinet Secretary Aden Duale condemned what he described as a “growing trend of fraudulent activities” that threaten the integrity of the country’s healthcare system.
“We have noted with great concern a growing trend of fraudulent activities being perpetrated by some healthcare facilities, healthcare workers, and even patients against the SHA Fund. These actions are illegal, unethical, and a direct betrayal of the trust placed in our health system,” Duale said.
At the center of the scandal is med-claim manipulation, where some healthcare facilities have been discovered to illegally converting outpatient visits to inpatient admissions to jack up payments.
In some instances, facilities have pressured health workers into admitting patients without medical grounds, all in an attempt to maximize payment from the SHA Fund.
Even more shocking are reports of patients themselves aiding in the deception.
In some instances, individuals have allegedly shared their SHA access codes with hospitals, allowing them to file claims for services never rendered.
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| SHA building in Nairobi |
“This kind of collusion is criminal,” Duale declared, adding that all involved from rogue doctors to complicit patients would face legal consequences, including possible arrest and facility shutdowns.
Additional schemes flagged include the misuse of pre-authorisation codes by doctors and the double billing of patients, where hospitals charge both the SHA Fund and patients in cash for the same services.
Patients facing such extortion have been urged to report to the SHA Call Centre via 147.
The most brazen fraud exposed involves “ghost patients,” with hospitals filing claims for non-existent individuals and inflating bed numbers to siphon more funds from the state.
This scandal marks yet another front in the government’s intensified war on healthcare fraud. In April, Duale announced a crackdown on unqualified health practitioners and illegally operating facilities, signaling a broader purge of malpractice in the sector.
“This abuse must end. We are rebuilding trust in the system, and anyone sabotaging that mission will face the full force of the law,” Duale warned.
The Ministry has vowed unrelenting action to restore accountability and ensure the SHA Fund serves its rightful purpose of supporting real patients with genuine health needs.
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