SHA fraud: 31 private health facilities closed
Health Cabinet Secretary Aden Duale addresses the media at the Ministry of Health headquarters in Nairobi, on April 10, 2025.
At least 31 private health facilities have been closed after being found guilty of converting outpatient to inpatient claims, Health Cabinet Secretary Aden Duale has announced.
Speaking in Kisumu on Sunday, Mr Duale said that the facilities had been found guilty of defrauding the Social Health Authority (SHA) by converting outpatient claims to inpatient claims.
He has put health practitioners and patients on high alert, warning them of severe consequences for defrauding the SHA fund.
A total of 35 health facilities have already been closed in an ongoing crackdown targeting unscrupulous activities draining the SHA’s resources, he added.
Mr Duale has outlined six key areas in which fraudsters will face the full force of the law:
1. Outpatient claim scams: Facilities converting outpatient claims to inpatient claims will be closed down without hesitation.
2. Forced admissions: Health workers colluding with facilities to admit patients unnecessarily will face disciplinary action, with both parties held personally responsible for any resulting fraud.
3. Code sharing: Patients sharing codes with hospitals to claim more services than received will be prosecuted alongside the doctors and facilities involved.
4. Pre-authorisation code abuse: Doctors sharing pre-authorisation codes to defraud the SHA fund will face prosecution.
5. Ghost patient admissions: Facilities admitting non-existent patients beyond their capacity will be brought to book.
6. Double billing: Facilities charging both SHA and patients in cash simultaneously will be reported through the call centre 147, with patients encouraged to speak out against such malpractices.
The CS stated that individuals found to have fraudulently earned money from the SHA will be reported to the Directorate of Criminal Investigations before being prosecuted.
