Duale Exposes Major Health Scheme Fraud, Warns of Immediate Crackdown
NAIROBI – Health Cabinet Secretary Aden Duale has sounded the alarm over a rising wave of fraud targeting Kenya’s public health insurance scheme. He confirmed that some hospitals, doctors, and patients are colluding to siphon funds from the Social Health Authority (SHA) Fund through coordinated, illegal actions.
In a formal statement, Duale described the trend as “a direct betrayal of the trust placed in our health system.”
He cited specific schemes used to defraud the fund. According to the ministry, some hospitals have been converting outpatient claims into inpatient ones to receive higher payouts. In other instances, patients were reportedly admitted without medical need, while some healthcare workers were allegedly pressured to inflate patient numbers.
Duale also disclosed that some patients have been handing over their SHA access codes to medical facilities to falsely claim services not rendered. Additionally, reports indicate some doctors are misusing pre-authorization codes, further enabling fraudulent reimbursements.
“This is clear fraud and will lead to immediate closure and legal action,” Duale said.
The Ministry has recorded cases where facilities admitted patients who do not exist or claimed to serve more patients than they could physically accommodate. Some institutions were found charging the SHA Fund while demanding cash payments from patients for the same services.
Duale labeled the acts “illegal and unethical,” and said they compromise public health delivery and waste taxpayer money. “Fraud against the SHA Fund undermines universal healthcare efforts and harms every Kenyan,” he stated.
The Ministry has warned that all facilities engaging in these schemes risk permanent closure without warning. Offending parties will face legal consequences.
To protect themselves, patients are encouraged to verify bills through the Afya Nyumbani mobile app and report suspicious charges using the USSD code *147#.
The SHA Fund, launched as part of Kenya’s universal healthcare push, was designed to support access to medical services for low- and middle-income households. However, this wave of fraud threatens to derail that mission.
Duale ended his statement with a firm warning: “We will not hesitate to take strong and swift action against any individual or institution found culpable.”
The Ministry of Health is expected to announce enforcement measures in the coming days.
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