Health Cabinet Secretary Aden Duale has sounded the alarm on the rising cases of healthcare fraud in Kenya, warning that the malpractice is not only a local concern but a global menace.
Speaking on Monday, Duale said fraud in the sector drains between 3 and 15 per cent of healthcare expenditures globally, diverting resources meant to save lives. “Healthcare fraud is a global problem, draining an estimated 3 per cent to 15 per cent of healthcare expenditures annually,” he noted.
Kenya, he said, is no exception. The Association of Kenya Insurers (AKI) estimates that fraudulent claims account for up to 30 per cent of all payouts in the country. “This isn’t just a challenge for us; it’s a systemic menace. Our rigorous enforcement is a necessity, not an option,” he said.
Since assuming office on April 1, 2025, the CS said his ministry has stepped up its crackdown on fraud. A new digital system has been introduced to monitor and flag irregularities in claims processing. “The primary function of our digital system is to detect fraud. Facilities are finding innovative ways to cheat the system, but our artificial intelligence module is designed to detect anomalies at every stage of the claims process,” Duale explained.
The intensified campaign has already seen 728 non-compliant facilities shut down, while 301 more were downgraded by the Kenya Medical Practitioners and Dentists Council (KMPDC).
Duale disclosed that fraudulent claims have cost the Social Health Insurance Fund (SHIF) billions. Out of Sh82.7 billion in claims submitted, Sh10.6 billion has been rejected due to fraud or non-compliance, with another Sh2.1 billion still under investigation.
He reiterated that safeguarding public resources is a constitutional obligation under Article 43(1)(a), which guarantees every Kenyan the right to the highest attainable standard of health. “Every shilling contributed to the Social Health Insurance Fund must go towards legitimate, life-saving healthcare,” he stressed.
The CS assured that his ministry will continue to enforce accountability in the sector to protect taxpayers’ money and ensure Kenyans receive quality, legitimate healthcare services.
