By Michelle Ndaga
The Ministry of Health has intensified its crackdown on fraud in Kenya’s healthcare sector, with 728 non-compliant facilities closed and 301 downgraded since April 2025.
CS Duale highlighted that fraudulent practices, including phantom billing, upcoding, falsification of medical records, and conversion of outpatient visits to inpatient claims, remain a major threat to the Social Health Insurance Fund (SHIF) and Universal Health Coverage (UHC) programs.
“Every shilling contributed to the Social Health Insurance Fund must go toward legitimate, life-saving healthcare,” he said, emphasizing the government’s constitutional duty under Article 43(1)(a) to guarantee the highest attainable standard of health.
Since the rollout of the TaifaCare program on October 1, 2024, health facilities have submitted claims totaling Ksh 91.7 billion across primary and secondary care.
Of this, Ksh 53 billion has been paid, Ksh 6.4 billion approved and awaiting payment, Ksh 10.6 billion rejected due to fraud, while claims totaling Ksh 12.1 billion are under review or re-evaluation.
The CS named several facilities involved in malpractice, including Nabuala Hospital in Bungoma, Kotiende Medical Centre in Homa Bay, and multiple facilities in Mandera that allegedly submitted overlapping fraudulent claims.
CS Duale also called on all Kenyans to participate in social accountability, reporting suspected fraud via SHA’s toll-free number 147, and reiterated that law enforcement will prosecute offenders while recovering misappropriated funds.
The Ministry is collaborating with private insurers such as Jubilee, AAR, and Old Mutual to establish a Joint Anti-Fraud Action to strengthen oversight, safeguard public resources, and ensure that all Kenyans have access to quality, affordable healthcare free from fraud.
