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The Social Health Authority (SHA) Fund, Kenya’s central health financing pillar, has come under serious threat as the government uncovers a complex network of fraud. Health Cabinet Secretary Aden Duale has sounded a strong warning, vowing that those caught defrauding the scheme—including health workers, facility owners, and even patients—will face legal consequences.
Among the most disturbing revelations is that several health facilities have been deliberately inflating claims to siphon more funds. In particular, outpatient visits have been fraudulently reclassified as inpatient services— a move designed to increase payouts from the SHA Fund. The government has stated that any facility involved in such manipulations risks closure and prosecution.
It's not just the providers. According to the CS, even some patients are now actively contributing to the rot. In some cases, individuals have gone so far as to share their access credentials with hospitals to help forge medical claims. This breach of integrity has turned the very beneficiaries of the health program into willing participants in criminal activity.
Another pattern that has emerged is unnecessary hospital admissions. Health workers are reportedly being pressured to admit patients without valid medical grounds simply to increase the value of claims submitted. This misuse not only distorts healthcare delivery but clogs already strained medical infrastructure.
Perhaps the most egregious scam is the invention of non-existent or “ghost” patients. These phantom admissions are used to file claims for services that were never rendered. Furthermore, some doctors have been found to be sharing pre-authorisation codes illegitimately, allowing the billing of treatments that never happened. This behavior represents a grave breach of medical ethics and a direct violation of law.
Many health facilities are now accused of double billing—charging patients cash while simultaneously billing the SHA Fund for the same services. This blatant exploitation not only steals from the national fund but also from struggling patients. The ministry is urging all victims to report such incidents directly to the SHA via the hotline 147.
This isn’t the first time the Ministry of Health has gone after fraud. Back in April 2025, a crackdown was initiated to weed out unqualified health practitioners and fraudulent facilities. This renewed effort marks a continuation of that purge, now widened to include even the patients and staff who manipulate the system for personal gain.
Health CS Duale has reiterated that fraud within the SHA Fund will not be tolerated, and that any individual or institution implicated in these schemes will face the full force of the law.
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