Duale Raises Alarm Over Rampant SHA Fraud, Vows Crackdown
According to the Ministry, these practices not only breach legal standards but also defy the ethical obligations expected from the medical community.
Health Cabinet Secretary Aden Duale. Photo/KBC Digital.
By Juliet Jerotich
Health Cabinet Secretary Aden Duale has expressed deep concern over a disturbing rise in fraudulent activities involving healthcare providers, medical personnel, and patients conspiring to exploit the Social Health Authority (SHA) Fund.
The Ministry of Health has issued a strong warning to medical service providers regarding the increasing number of scams targeting the public health insurance scheme.
In a formal statement, CS Aden Duale disclosed that the government is tracking a growing pattern of deceitful practices by certain hospitals, doctors, and even patients who are working together to siphon money from the SHA Fund.
“We are gravely concerned by the emergence of fraudulent practices being carried out by some health facilities, practitioners, and patients against the Social Health Authority Fund. These acts are not only illegal but also a serious violation of the integrity and trust placed in our healthcare system,” the statement read.
The Ministry highlighted specific cases in which outpatient claims are being falsely converted to inpatient ones to obtain higher reimbursements from the fund.
Reports also indicate that patients are being admitted without medical necessity, while some medical staff are being pressured into inflating admission numbers without clinical grounds.
Duale further revealed instances where patients are handing over their SHA access codes to healthcare providers to enable false claims for services that were never rendered.
Additionally, some doctors are reportedly misusing or distributing pre-authorization codes to support these fraudulent claims.
According to the Ministry, these practices not only breach legal standards but also defy the ethical obligations expected from the medical community.
The government has stated clearly that such fraudulent conduct will be met with zero tolerance, and any facility found culpable risks being shut down without prior notice.
Other identified violations include fake patient admissions and billing the SHA Fund while simultaneously charging patients cash for the same services.
“Some facilities are reporting admissions for individuals who do not exist or are surpassing their licensed capacity. This is outright fraud, and such institutions will face immediate closure and prosecution. In other cases, double billing is occurring where patients are being charged despite the fund having already covered the service,” Duale added.
The Cabinet Secretary urged Kenyans to cross-check their medical charges using the Afya Nyumbani app or report suspected fraud cases by dialing *147#.
“Fraud targeting the SHA Fund undermines the country’s goal of universal health coverage and negatively impacts every citizen. We will act swiftly and firmly against any persons or institutions involved,” Duale warned.
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