Ministry of Health, Insurers Agree on Joint Anti-Fraud Action
𝐍𝐚𝐢𝐫𝐨𝐛𝐢, 𝐊𝐞𝐧𝐲𝐚 - 𝟏𝟖𝐭𝐡 𝐀𝐮𝐠𝐮𝐬𝐭 𝟐𝟎𝟐𝟓
The Ministry of Health is engaging strategic partners to bridge the financial gap in the health sector while rolling out a Joint Anti-Fraud Action to eliminate ghost patients, penalize malpractice, and restore public trust.
Health Cabinet Secretary held a bilateral with Chief Executive Officers of Medical Insurance Companies at Afya House, Nairobi, to explore areas of partnership, particularly with the Social Health Authority (SHA), aimed at expanding access to quality and affordable healthcare for all Kenyans, regardless of age or economic status.
The meeting agreed on anti-fraud measures including biometric verification, joint audits, and a shared database of fraudulent providers.
The CS briefed the CEOs on the Taifa Care reforms anchored in the Social Health Insurance Act, Primary Health Care Act, Digital Health Act, Facility Improvement Financing Act, and the forthcoming Quality of Care and Patient Safety Bill. These reforms establish a regulator for service standards — all pivotal in advancing Kenya’s Universal Health Coverage (UHC).
To strengthen the partnership, the meeting agreed on:
1️⃣Complementary Coverage — Insurers to offer plans beyond SHA’s package, such as overseas care, elective procedures, or premium add-ons; and co-finance chronic care alongside SHA’s Emergency, Chronic, and Critical Illness Fund (ECCIF).
2️⃣Shared Claims & Data — Linking insurers to SHA’s centralized claims platform for real-time verification, faster processing, and prevention of double billing, in line with the Digital Health Act (2023) and Data Protection Act (2019).
3️⃣Aligned Empanelment Standards — Harmonized accreditation criteria to guarantee all Kenyans, whether insured by SHA or private schemes, receive quality care under the same standards.
The CEOs requested the Ministry’s support in strengthening the National Health Registry to provide a standardized and accessible platform for healthcare information, and the establishment of a regulatory framework for drug pricing to enhance transparency, accountability, and integrity in the sector.
In his remarks, Hon. Duale acknowledged structural challenges facing the health system, noting that the Ministry is addressing them through laws and data-backed reforms to restore public trust. He called for a Public–Private Collaborative framework between MoH, SHA, the Association of Private Insurers, and IRA — starting with tariff alignment, data sharing, and fraud elimination.
The CS was joined by PS for Medical Services Dr. Ouma Oluga, Dr. Mercy Mwangangi (CEO, SHA), Eng. Anthony Lenayara (CEO, DHA), Dr. David Kariuki (CEO, KMPDC), together with industry leaders including Njeri Njomo (CEO, Jubilee Health Insurance), Justine Kosgey (CEO, AAR Insurance), and Japeth Ogalloh (CEO, Old Mutual), among others.