Duale raises alarm over rampant SHA fraud, vows crackdown

The Ministry of Health has issued a stern warning to health service providers over the rising cases of fraud targeting the Social Health Authority (SHA) Fund.

In a statement, Health Cabinet Secretary Aden Duale said the government has observed a worrying trend involving healthcare facilities, doctors, and even patients colluding to defraud the public health insurance scheme.

“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. These actions are illegal, unethical, and a direct betrayal of the trust placed in our health system,” the statement read.

The Ministry raised the alarm over incidents where some healthcare facilities are converting outpatient claims into inpatient claims in a bid to receive higher reimbursements from the fund.

In some cases, patients are reportedly being admitted unnecessarily, with health workers coerced into inflating patient numbers without medical justification.

Duale also revealed that some patients are sharing their SHA access codes with healthcare providers to fraudulently claim services they have not received.

In addition, some doctors are accused of misusing or sharing pre-authorization codes, further aiding fraudulent claims.

According to the Ministry, such conduct not only violates the law but also goes against the ethical standards expected of medical professionals.

The government warned that such blatant fraud will not be tolerated, and facilities engaged in these activities risk closure without notice.

Other violations include the admission of nonexistent patients and double charging.

“Some facilities are claiming admissions for patients who do not exist or are exceeding their physical capacity to house patients. This is clear fraud and will lead to immediate closure and legal action, while others are billing both the SHA Fund and demanding cash payments from patients for the same services,” Duale noted.

The CS urged patients to verify all charges through the Afya Nyumbani mobile app and report suspected cases of fraud by dialling *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,” Duale warned.