The Ministry of Health has issued a stern warning to healthcare providers engaged in fraudulent activities, revealing that the Social Health Authority (SHA) has rejected over Sh10.6 billion in claims due to suspected fraud and non-compliance since the rollout of the TaifaCare program.

In a press conference held at Afya House on Monday, Cabinet Secretary for Health, Aden Duale, addressed the swirling allegations of “ghost hospitals” and widespread corruption, reaffirming the government’s “uncompromising stance against fraud.”

“Our position on safeguarding public resources has been consistent, clear, and unwavering,” said CS Duale. “Every shilling contributed to the Social Health Insurance Fund must go towards legitimate, life-saving healthcare.”

The Ministry’s intensified anti-fraud campaign has led to the closure of 728 non-compliant facilities and the suspension of an initial 40 hospitals, with another 45 currently being degazetted pending further investigation.

According to the statement, since the TaifaCare rollout on October 1, 2024, health facilities have submitted claims totalling Sh82.7 billion to the SHA. 

Of this, Sh53 billion has been paid out. However, a rigorous digital audit system flagged numerous irregularities.

The audits uncovered a litany of troubling practices, including:

Phantom Billing: Submitting claims for services rendered to non-existent patients.

Upcoding: Billing for more expensive procedures than those actually performed.

Falsification of Records: Submitting altered or false medical documentation.

Inpatient Conversion: Illegally billing for inpatient admissions for what were simple outpatient visits.

Several facilities were named for specific fraudulent activities. Nabuala Hospital in Bungoma was cited for allegedly falsifying claims for multiple Caesarean sections on the same patient within days. 

In Homa Bay, Kotiende Medical Centre was flagged for having a single person supposedly signing off on both day and night shifts for consecutive days, an impossible feat. 

A group of facilities in Mandera allegedly colluded to submit 312 fraudulent claims for patients admitted simultaneously across multiple locations.

“This is just a brief overview. We will make a detailed report public to ensure full transparency,” the Cabinet Secretary stated, issuing a final warning. 

Any facility, doctor, or patient found to be involved in fraudulent activities will be held liable and face the full force of the law.

CS Duale emphasised that the fight against corruption is a core pillar of the new Taifa Care program and is rooted in the constitutional right of every Kenyan to the highest standard of health. 

He called upon all Kenyans to participate in ensuring public money is used prudently by reporting any suspicious activities through a toll-free number, 147.

The Ministry also addressed the legacy debt from the defunct National Health Insurance Fund (NHIF), assuring that the government will pay all verified claims of Sh 0-10 million.

Looking ahead, the Ministry announced the formation of a “Joint Anti-Fraud Action” initiative in collaboration with leading medical insurance companies to strengthen collaboration and crack down on malpractice across the sector.

“Our work has just begun,” CS Duale concluded. “We will not rest until every Kenyan has access to quality, affordable, and dignified healthcare, free from the burden of fraud.”