The Ministry of Health has unveiled a strategic collaboration with medical insurers to combat fraud, enhance efficiency, and build a sustainable framework for Universal Health Coverage (UHC). The initiative, dubbed the Joint Anti-Fraud Action, aims to eliminate ghost patients, penalize malpractice, and restore public trust in the healthcare system.
During high-level discussions at Afya House, top executives from leading insurance companies agreed with the Ministry to roll out key anti-fraud measures. These include biometric verification for patients, joint audits of facilities, and the establishment of a shared database of fraudulent providers. By adopting these measures, both government and private players hope to seal loopholes that drain billions from the health sector every year.
The meeting also explored ways to deepen collaboration between insurers and the Social Health Authority (SHA) under the ongoing Taifa Care reforms. These reforms are anchored in a set of progressive health laws, including the Social Health Insurance Act, Primary Health Care Act, Digital Health Act, and the Facility Improvement Financing Act. Together, they aim to guarantee quality and affordable care for all Kenyans while establishing a regulator to uphold service standards.
Three key partnership pillars were agreed upon. First, Complementary Coverage, where insurers will provide services beyond SHA’s package, such as overseas care, elective procedures, and premium add-ons, while co-financing chronic care under the Emergency, Chronic, and Critical Illness Fund (ECCIF). Second, Shared Claims and Data, which will see insurers linked to SHA’s centralized claims platform for real-time verification and prevention of double billing, in line with Kenya’s Digital Health and Data Protection laws. Third, Aligned Empanelment Standards, ensuring that all health facilities meet uniform accreditation criteria so patients enjoy quality care regardless of their insurer.
Insurers also called for the strengthening of the National Health Registry to provide a unified information platform, and for the creation of a regulatory framework for drug pricing to enhance transparency and accountability in the pharmaceutical sector.
The Ministry reaffirmed its commitment to addressing structural challenges in the health system, emphasizing that data-driven reforms and public–private collaboration will be critical to achieving UHC. The joint action plan, beginning with tariff alignment, data sharing, and fraud elimination, is expected to set a new standard in Kenya’s healthcare governance.
