Government Cracks Down on SHA Fraud, Shuts 1,118 Health Facilities as Sh11 Billion Probe Begins
The health CS repeated government commitment to enhance the SHA system which will produce efficient and transparent and sustainable healthcare services.
Health Cabinet Secretary Adan Duale. Photo/Courtesy
By Ruth Sang
The national government has established stricter regulations for the Social Health Authority (SHA) system to support its ongoing battle against fraud while enhancing healthcare services across the entire country.
Health Cabinet Secretary Adan Duale announced that authorities have commenced investigations into the theft of approximately Sh11 billion from the SHA system which occurred during the period between October 2024 and April last year. The CS stated that fraudulent loss of funds occurred because of fictitious and excessive billing along with unapproved medical procedures and phantom patients and staff members who worked together with healthcare providers.
Duale explained that the investigations will determine who holds responsibility for both institutional and personal accountability. He announced that disciplinary measures have started against facilities which received proof of their responsibility although he indicated that institutions will face consequences if fraud is confirmed through evidence.
The government has terminated operations at 1,118 healthcare facilities across the country as part of its fraud crackdown after authorities connected these facilities to unauthorized activities which occurred through the SHA system. The institutions which faced consequences include private hospitals and county health facilities and national referral hospitals while private facilities lead the list of offenders. Duale warned that additional closures might happen according to the investigation results while he emphasized that the government plans to take strong measures for public fund protection.
The Cabinet Secretary explained that the fraudulent claims were submitted during the SHA system transition which he identified as a time when system changes and increased enrollment made the system vulnerable to exploitation. The government plans to eliminate the vulnerabilities that resulted in these financial losses while developing better oversight systems to stop future financial misconduct.
Duale demonstrated SHA program success despite existing challenges because more than 29 million Kenyans have registered for the program. The company has received more than Sh130 billion in contributions while it has paid Sh93.3 billion to healthcare facilities for services they provided to patients.
CS expressed serious concern about the widespread practice of fraudulent maternity care claims. The facilities used methods to exaggerate their number of Caesarean section deliveries which allowed them to obtain greater reimbursement amounts. The SHA system provides Sh30,000 reimbursement for Caesarean section procedures whereas normal deliveries receive Sh10,000 reimbursement.
Duale reported that investigations uncovered situations where facilities claimed that 97 percent of their maternity cases were Caesarean sections which he considered both medically doubtful and financially driven. He emphasized that these practices waste public resources while they also damage trust in the healthcare system.
The Health CS repeated government commitment to enhance the SHA system which will produce efficient and transparent and sustainable healthcare services. The government will bring all individuals and institutions who took part in the fraud scheme to justice while working to restore confidence in national health financing system.
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