By Michelle Ndaga
A major medical insurance scandal has rocked counties after an exposé by The Standard revealed that billions of shillings in premiums paid for county workers have not translated into healthcare access, with hospitals rejecting insured patients.
The investigation highlighted the plight of Abdulahi*, a 45-year-old Isiolo employee reliant on an oxygen machine costing KSh 700 an hour. Despite holding a valid insurance card, no hospital accepted it, forcing his family to cover escalating costs. Similar stories are emerging nationwide, with insurance cards proving worthless in both public and private facilities.
Government authorities have begun to act. The Social Health Authority (SHA) has shut down 31 hospitals accused of double-billing patients and filing fraudulent claims. Parallel investigations by Citizen Digital uncovered a widespread fraud ring, especially in Level 4 and 5 hospitals, where schemes included ghost patient admissions, inflated inpatient claims, and misuse of authorization codes. The fraudulent payouts are estimated at nearly KSh 100 million.
Health Cabinet Secretary Aden Duale has promised stern measures, including forwarding implicated hospitals and individuals to the DCI for prosecution. However, critics argue the crackdown is too little, too late, as workers continue to suffer denials of care despite counties faithfully paying premiums.
SHA CEO Dr. Mercy Mwangangi is yet to fully address the scale of the scandal, sparking anger from unions and watchdog groups. Advocacy organizations warn the scandal undermines trust in public health financing and exposes deep governance failures.
With mounting calls for accountability, the unfolding scandal has become a litmus test for the government’s commitment to protecting public funds and ensuring county workers access the healthcare they have already paid for.
