NAIROBI, Kenya — Health Cabinet Secretary Aden Duale has dismissed claims that Kenya lost Sh11 billion through fraudulent medical claims under the Social Health Authority (SHA), insisting that the flagged amounts were detected and blocked before public funds were paid out.
The Ministry of Health has faced renewed scrutiny following reports that billions of shillings may have been siphoned within six months through fictitious surgeries and irregular insurance claims, raising questions about whether SHA has resolved governance failures that plagued the defunct National Health Insurance Fund (NHIF).
Speaking during an interview on Citizen TV’s JKLive on Tuesday, Duale pushed back against assertions of losses, saying the figures being cited represent claims rejected by the system rather than money stolen.
“As of this evening, we have rejected Sh11.6 billion in fraudulent claims,” Duale said. “Every coin of a Kenyan paid for healthcare insurance—if you steal it, the system will detect you, flag you and the government will prosecute you.”
However, the Cabinet Secretary did not directly confirm whether any funds had been lost before detection. Instead, he maintained that only about Sh1 billion had been paid after undergoing verification and approval processes.
Duale framed the controversy as proof that SHA’s fraud-detection architecture is functioning, arguing that suspicious claims were intercepted before payouts were made.
Addressing persistent public perceptions of corruption within the Ministry of Health, Duale defended his leadership and rejected calls for his resignation.
“When I went there, that time I denied it. After three weeks, I realised there was some truth about why Kenyans called it Mafia House, but today it is Afya House,” he said. “Why should I resign? If I violate my oath, Parliament can impeach me, the criminal justice system can deal with me, or the President can act.”
He described insurance fraud as a global challenge and said Kenya was not an outlier.
“Fraud in the insurance industry is a global problem. Digitisation is the key,” Duale said. “The digital health system detects patterns.”
He added that individuals who exploited weaknesses in NHIF systems attempted to migrate to SHA but were blocked due to institutional separation between SHA and the Digital Health Agency.
“SHA is one entity, and the Digital Health Agency is another, working together. That separation has strengthened oversight,” he said.
Duale also disclosed that his ministry had uncovered troubling patterns of abuse by some health facilities. Speaking earlier to Members of Parliament during a retreat in Naivasha, he cited cases where expectant mothers were allegedly subjected to unnecessary Caesarean sections to inflate insurance claims.
“Somebody wants to force a mother into a C-section when she can deliver normally just to get an extra Sh20,000,” Duale said. “We found a facility with no theatre that had submitted 35 C-section claims.”
The Cabinet Secretary said investigations were ongoing and warned facilities and individuals involved in fraudulent practices that prosecutions would follow.
He further cited growing uptake of SHA products, noting that 420,000 Kenyans had enrolled in the Lipa Pole Pole programme, contributing Sh1.4 billion toward access to specialised care.
The debate has intensified scrutiny of SHA’s governance, with critics questioning whether fraud controls are preventative or merely reactive after public funds are exposed to risk. The Ministry of Health maintains that ongoing reforms, digitisation and enforcement will restore public confidence in universal health coverage.
