The Ministry of Health has suspended 40 health facilities, eight doctors, and four clinicians from accessing services under the Social Health Authority (SHA) after being linked to fraudulent activities. The suspensions, effective immediately, follow a comprehensive digital audit and forensic review of suspicious claims over the past two months.
According to the Ministry, the targeted facilities and professionals engaged in corruption and theft of public resources. Authorities will surcharge them to recover any funds already paid based on fraudulent claims. The list of suspended facilities, covering counties such as Nairobi, Homa Bay, Bungoma, Mandera, Kakamega, Busia, Kilifi, Wajir, Kajiado, and Kirinyaga, has been published in the Kenya Gazette.
The audit revealed four main fraud tactics:
- Upcoding – claiming payment for more expensive procedures than those performed.
- Falsifying medical records – such as billing for patients admitted elsewhere at the same time.
- Exaggerating outpatient visits – converting them into extended inpatient stays.
- Duplicate claims – colluding to create ghost patients and siphon funds.
Specific examples include a Nairobi hospital billing Sh201,600 for a bladder tumour procedure when only a Sh89,600 prostatectomy was done, and Mandera facilities lodging duplicate claims for the same patient.
The implicated doctors and clinicians have had their SHA and Digital Health Authority platform access revoked, with their respective regulatory bodies notified for possible licence cancellation. The Directorate of Criminal Investigations will pursue further legal action.
The Ministry warned that no medical procedure can be performed and paid for without a one-time password (OTP) from the authorised professional. Patients were also urged not to share OTPs or personal details, with biometric verification planned for lower-level facilities to curb misuse.
Officials also reminded citizens that primary healthcare services at public, private, and faith-based facilities are fully funded by the Primary Healthcare Fund and must not attract out-of-pocket payments.
Suspended hospitals can only be reinstated after meeting corrective measures set by regulators. Authorities stressed that lobbying will not influence reinstatement, as digital monitoring will detect any future fraud attempts in real time.
With over 25 million Kenyans registered under SHA, the government has vowed to protect the scheme from collapse and ensure it delivers quality, legitimate healthcare to all contributors.
