Health Cabinet Secretary Aden Duale has issued a stern warning to hospitals and doctors involved in fraudulent claims under the newly established Social Health Authority (SHA). Duale, addressing a press conference in Nairobi, emphasized that contractual agreements with SHA are made with individual facilities, not through associations, citing examples like Nairobi Hospital, Aga Khan, Kenyatta National Hospital, and Kenyatta University Hospital. He declared that any facility, doctor, or patient found engaging in fraudulent dealings will be held liable, facing prosecution and forced refunds. The Ministry has already initiated efforts to recover misused funds and will collaborate with law enforcement agencies, urging Kenyans to report suspicious activities via SHA’s toll-free number 147 to protect the social health insurer.

This warning follows the recent suspension of 40 health facilities, eight doctors, and four clinicians from accessing SHA services. The suspensions, effective immediately, were a result of a comprehensive digital audit and forensic review that uncovered various fraudulent schemes over the past two months. These schemes included upcoding, falsifying medical records, exaggerating outpatient visits into extended stays, and colluding to lodge duplicate claims for the same patient. A notable instance involved a Nairobi hospital billing Sh201,600 for a bladder tumour surgery but only performing a procedure costing Sh89,600. The implicated facilities are spread across counties like Nairobi, Homa Bay, Bungoma, Mandera, Kakamega, Busia, Kilifi, Wajir, Kajiado, and Kirinyaga. Eight doctors linked to facilities in Nairobi, Bungoma, and Kilifi, along with four clinicians from Nairobi and Homa Bay, were directly involved. Their access to SHA and Digital Health Authority has been revoked, and relevant professional bodies, including the Kenya Medical Practitioners and Dentists Council and Clinical Officers Council, have been notified for disciplinary action. The Directorate of Criminal Investigations (DCI) will also receive the list of implicated parties for potential prosecution to recover fraudulently claimed funds.

Amidst these efforts to combat fraud, the Social Health Authority faces scrutiny regarding its transparency. SHA recently removed from its website a detailed list of payments made to hospitals. Concurrently, the Kenya Master Health Facility Registry (KMHFR), a critical public database containing information on health facilities' geographical locations, bed capacities, and regulatory bodies, was also disabled on Monday evening. This move has sparked significant uproar, particularly from the Rural and Urban Private Hospitals Association of Kenya (RUPHA). Dr. Brian Lishenga, RUPHA chairperson, criticized the action, stating it goes against the right to access information and indicates the ministry's lack of control over its own data and regulators. RUPHA has threatened legal action and protests, accusing the ministry of attempting to conceal corruption and demonstrating inefficiency, especially as the KMHFR is the very platform the ministry uses to contract facilities. Concerns were raised about irregular disbursements, including payments to