40 Health Facilities Suspended Over Fraudulent Claims to Social Health Authority
𝐍𝐚𝐢𝐫𝐨𝐛𝐢, 𝐊𝐞𝐧𝐲𝐚 - 𝟖𝐭𝐡 𝐀𝐮𝐠𝐮𝐬𝐭 𝟐𝟎𝟐𝟓
The Ministry of Health has suspended 40 health facilities across the country after uncovering widespread fraudulent claims to the Social Health Authority (SHA), in what Cabinet Secretary for Health Hon. Aden Duale has described as a “grave threat” to the sustainability of Kenya’s universal health coverage agenda.
The suspensions, announced at Afya House and published in Kenya Gazette No. 168 of
, 2025, follow a month-long forensic audit by SHA’s digital health system, which flagged suspicious claims.
The CS said the review uncovered multiple fraudulent practices, including:
▪️Upcoding: Claiming for more expensive procedures than those performed.
▪️Falsification of records: Submitting altered medical information to inflate claims.
▪️Conversion of outpatient visits to inpatient care: Billing for services patients deny receiving.
▪️Multiple billing and ghost patients: Collusion between facilities to claim for the same patient.
Facilities implicated include hospitals in Nairobi, Bungoma, Homa Bay, Mandera, Kilifi, and other counties. The Ministry has also withdrawn SHA platform access rights from eight doctors and four clinical officers linked to the fraud, and forwarded their names to the Directorate of Criminal Investigations (DCI) for prosecution.
Regulatory bodies — the Kenya Medical Practitioners and Dentists Council and the Clinical Officers Council — have been asked to begin disciplinary proceedings that could result in licence cancellation.
The CS stressed that fraudulent activities witnessed under the defunct National Health Insurance Fund will not be tolerated under SHA. “Any healthcare provider whose information is used to defraud SHA will be held personally liable,” he said, adding that facilities will be surcharged to recover funds already paid out on false claims.
Duale urged Kenyans to protect their SHA One-Time Passwords (OTPs) and personal details, warning that members whose OTPs are used to commit fraud will also be held accountable. He noted that the Ministry has rolled out biometric verification in Level 4, 5, and 6 facilities to curb OTP misuse, with expansion to Level 2 and 3 facilities planned.
The Ministry is encouraging the public to report suspected fraud directly to SHA via the toll-free number 147. “We remain steadfast in protecting every shilling contributed by Kenyans to ensure it delivers legitimate, quality healthcare,” the CS said.