Dozens of public hospitals across Kenya are facing investigations over a growing scandal involving fraudulent medical claims submitted to the Social Health Authority (SHA), in what officials are calling one of the most elaborate healthcare scams in recent history.
An internal report has unearthed systemic malpractice within Level 4 and Level 5 hospitals, where outpatient visits were allegedly converted into false inpatient claims. Some patients were reportedly admitted without medical necessity, while in more alarming cases, ghost patients were registered in already overcrowded facilities.
According to the report, the fraud appears to be a well-coordinated network involving rogue healthcare workers, complicit patients, and administrative loopholes. Whistleblowers within the system have come forward, providing the Ministry of Health with damning details on how authorization codes were shared to manipulate billing and inflate claims.
Health Cabinet Secretary Aden Duale, speaking in Kisumu County on Saturday, vowed swift action against those involved.
“We will not allow rogue facilities to milk SHA dry,” Duale said. “Files of implicated hospitals have been forwarded to the Directorate of Criminal Investigations (DCI), and more will follow.”
A senior source at the Ministry of Health confirmed that the SHA has already suspended services at facilities in over 10 counties.
The Kenya Medical Practitioners and Dentists Council (KMPDC) is reportedly preparing to revoke licenses of facilities and individuals implicated in the scandal.
Authorities have also warned patients against participating in the scheme, with some found to have willingly shared their personal hospital codes in exchange for cash.
The scandal has sparked fresh concerns over accountability in Kenya’s public healthcare system, even as reforms under the Universal Health Coverage plan continue to face resistance and systemic challenges. Investigations are ongoing.
