NAIROBI, Kenya – The government has launched a sweeping crackdown on fraud targeting the newly established Social Health Authority (SHA) Fund, shutting down 31 private hospitals and warning that both healthcare providers and patients found engaging in dishonest practices will face prosecution.
Health Cabinet Secretary Aden Duale, speaking on Sunday, said the ministry had uncovered widespread abuse of the SHA Fund through unethical schemes such as billing for ghost patients, forced hospital admissions, and manipulation of patient access codes to claim payments for services not rendered.
“We have noted with great concern a growing trend of fraudulent activities being perpetrated by some healthcare facilities, healthcare workers, and even patients,” Duale said. “These actions are illegal, unethical, and a direct betrayal of the trust placed in our health system.”
Fraud Schemes Exposed
The crackdown follows a series of audits and tip-offs that revealed how some facilities were admitting patients unnecessarily, manipulating pre-authorisation codes, or processing payments for fictitious treatments.
Duale cited instances where health workers were coerced into inflating claims and where hospitals billed both patients and the SHA Fund for the same services — a practice known as double billing.
Other facilities, the ministry revealed, had exceeded their licensed bed capacity or claimed to admit patients who never visited the facility at all.
“Fraud against the SHA Fund harms every Kenyan. We will not hesitate to take strong and swift action against any individual or institution found culpable,” said Duale, adding that all facilities found violating SHA rules would be immediately shut down and their owners prosecuted.
Doctors and Patients on Notice
The Health CS further warned that individual doctors and facility administrators involved in the fraudulent schemes would be held personally accountable.
He called on medical professionals to uphold their ethical obligations and shun participation in illegal billing practices.
“Such conduct violates professional ethics and the law. We will not tolerate it,” Duale emphasized.
Patients were also cautioned against colluding with facilities to facilitate fraud. Sharing personal access codes, enabling false billing, or knowingly submitting to unnecessary admissions could result in criminal charges, the ministry warned.
To counter misuse of the Fund, patients are encouraged to verify hospital charges and service records through the government’s Afyangu app and report any suspected fraud by dialling *147#.
Protecting Universal Health Coverage
The SHA Fund, which replaced the controversial NHIF, is a key pillar of President William Ruto’s Universal Health Coverage (UHC) plan.
But its rollout has been mired in legal and administrative controversy — including a recent High Court ruling declaring the 2.75 per cent salary deduction for the Fund illegal.
Despite the ruling, Duale insisted that the deductions remain in effect pending further legal clarification.
Health policy experts have warned that unless systemic fraud is curbed, public confidence in the SHA could erode, undermining the broader UHC reform agenda.
“The government is committed to safeguarding the integrity of the SHA Fund. Let this serve as a final warning to all would-be fraudsters,” the Authority said in a statement.
