Kenya's Ministry of Health, under Cabinet Secretary Aden Duale, has declared an uncompromising war against rampant fraud within the Social Health Authority (SHA) and its new TaifaCare program. Duale has issued stern warnings to hospitals, doctors, and patients, cautioning against fraudulent claims and vowing prosecution and forced refunds for offenders. He emphasized that contractual agreements under the SHA Act are signed directly with individual facilities, not associations, citing major hospitals like Nairobi Hospital and Aga Khan as examples of institutions holding independent contracts with SHA.

The Ministry's intensified anti-fraud campaign has revealed a disturbing scale of irregularities, leading to the rejection of over Sh10.6 billion in claims due to suspected fraud and non-compliance since TaifaCare's rollout on October 1, 2024. Of the Sh82.7 billion in claims submitted by health facilities to SHA, Sh53 billion has been paid, but a rigorous digital audit system flagged numerous dubious practices. These fraudulent activities include phantom billing for non-existent patients, upcoding (billing for more expensive procedures than performed), falsification of medical records, and illegally converting simple outpatient visits into inpatient admissions. Examples cited include Nabuala Hospital in Bungoma allegedly falsifying claims for multiple Caesarean sections on the same patient within days, Kotiende Medical Centre in Homa Bay flagging a single person for both day and night shifts for consecutive days, and a group of facilities in Mandera colluding to submit 312 fraudulent claims for patients admitted simultaneously across multiple locations. In another instance, a Nairobi hospital billed Sh201,600 for a bladder tumor surgery but only performed a procedure costing Sh89,600.

In response to these findings, the Ministry has taken decisive action, suspending 40 health facilities, eight doctors, and four clinicians from accessing SHA services. This followed a comprehensive digital audit and forensic review of suspicious claims over the past two months. The suspensions, effective immediately, are part of a broader crackdown that has seen the closure of 728 non-compliant facilities, with another 45 currently being degazetted pending further investigation. The list of suspended facilities, published in the Kenya Gazette, spans various counties including Nairobi, Homa Bay, Bungoma, Mandera, Kakamega, Busia, Kilifi, Wajir, Kajiado, and Kirinyaga. Duale asserted that offenders will be surcharged to recover any money paid based on fraudulent claims. Access to SHA and Digital Health Authority has been revoked for the implicated doctors and clinicians, and their respective regulatory bodies—the Kenya Medical Practitioners and Dentists Council and Clinical Officers Council—have been notified for potential disciplinary action. The Directorate of Criminal Investigations (DCI) will also receive the full list for possible prosecution.

Addressing the legacy debt from the defunct National Hospital Insurance Fund (NHIF), Duale stated that verified claims of up to Sh10 million will be paid through a supplementary budget in October, while larger claims will undergo strict verification. He stressed the government's constitutional and moral duty to pay only for legitimately rendered services. SHA has already disbursed Sh9 billion for primary healthcare, and delayed payments to hospitals serving public servants are expected to be cleared shortly. Furthermore, SHA is collaborating with private medical insurers to establish a joint anti-fraud initiative to strengthen efforts across the sector. Duale reiterated his commitment to ensuring every Kenyan has access to quality, affordable, and dignified healthcare free from fraud, urging citizens to report suspicious activities via the toll-free number 147.

Despite the Ministry's strong stance against fraud, recent actions by SHA have raised significant concerns regarding transparency. The Social Health Authority has recently removed from its website a list detailing payments of claims to hospitals. Concurrently, the Kenya Master Health Facility Registry (KMHFR) was disabled, severely hindering the public's ability to verify hospital details, track payments, and identify