Kenya’s healthcare sector is embroiled in fresh controversy as the Kenya Healthcare Federation (KHF) has publicly challenged Health Cabinet Secretary Aden Duale to prosecute those responsible for alleged fraud amounting to Sh11 billion in the Social Health Authority (SHA) system.
The claims stem from a Ministry of Health audit revealing that Sh11 billion was lost to fraudulent activities between October 2024 and April 2025, primarily through fake claims submitted by private hospitals.
These included falsified records, phantom billing, implausible surgical procedures (such as facilities claiming impossibly high rates of caesarean sections), and other irregularities flagged by the SHA’s AI-driven detection system.
Duale has emphasized that many such claims were rejected, preventing further payouts, and actions like barring dozens of medics from the platform and delisting over 1,000 facilities have already been taken.
However, hospitals, through representatives like Dr. Lishenga of the KHF, deny blanket culpability and demand evidence-based prosecutions rather than broad accusations.
They question the absence of arrests despite the massive sum involved, calling for the immediate prosecution of any guilty SHA officials who authorized payments and implicated hospital owners or executives.
The federation has also urged the publication of detailed payment data to promote transparency and allow providers to address specific allegations.
This standoff highlights ongoing tensions in the transition to universal health coverage under SHA, with providers insisting on fair reimbursement amid financial strains, while the government vows to recover funds and hold perpetrators accountable. The public awaits concrete legal actions to restore trust in the system.
Author: Bashirjuma
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