Health Cabinet Secretary Aden Duale has issued a stern and final warning over a growing wave of fraudulent schemes targeting the Social Health Authority (SHA) Fund, declaring that individuals and institutions found culpable will face swift and decisive legal action.
In an official statement shared on his X account on Sunday, June 29, 2025, Duale said the ministry had uncovered multiple forms of malpractice being perpetrated by healthcare facilities, health workers, and even patients.
He described the actions as illegal, unethical, and a betrayal of the public’s trust in Kenya’s health system.
“We have noted with great concern a growing trend of fraudulent activities being perpetrated by some healthcare facilities, healthcare workers, and even patients against the Social Health Authority (SHA) Fund,” he said.
Among the violations cited was the misrepresentation of claims, where facilities falsely convert outpatient visits into inpatient claims to inflate payouts from the Fund.
“This is a serious offence. Any facility found engaging in this malpractice will be shut down immediately and prosecuted,” he said.
Forced admissions
Duale also highlighted reports of forced admissions, revealing that some health workers are being pressured to admit patients unnecessarily, purely to boost claim values.
“This is unacceptable. Facilities and health workers found colluding in this practice will face disciplinary and legal action,” he said, adding that both individuals and facility owners would be held personally responsible.
He went on to expose cases of misuse of patient access codes, where patients reportedly share their login credentials with hospitals to fraudulently claim for services never rendered.
“This constitutes criminal fraud. Any patient, doctor, or facility involved will be prosecuted to the full extent of the law,” he declared.
Further, the ministry flagged the abuse of pre-authorisation codes, saying some doctors are sharing or manipulating these codes to submit false claims.
Duale condemned the trend, warning that it violates both medical ethics and national laws.
In a particularly troubling revelation, he pointed to the admission of ‘ghost’ patients, stating that some facilities are submitting claims for nonexistent individuals or exceeding their physical capacity to house patients.
“This is clear fraud and will lead to immediate closure and legal action,” he stated.
Another alarming practice identified was double charging, where facilities bill both the SHA Fund and patients for the same services.
Duale noted that such fraud undermines the very foundation of Kenya’s push toward universal healthcare.
“This is illegal. Patients are encouraged to report such cases by calling the SHA Call Center on 147. Fraud against the SHA Fund undermines universal healthcare efforts and harms every Kenyan. We will not hesitate to take strong and swift action against any individual or institution found culpable,” he said.
He closed with a firm warning to all players in the health sector, stating that the notice he had issued was final, and that anyone caught engaging in such fraud would face immediate disciplinary action.
“Let this serve as a final warning,” he declared.
