The Social Health Authority (SHA) has thwarted the loss of hundreds of millions of shillings to fraudulent health insurance claims, Health Cabinet Secretary Aden Duale has revealed. Speaking before the Senate on Wednesday, Duale disclosed that SHA’s digital audit system had flagged and rejected fake claims worth Sh10.6 billion, saving taxpayers from massive losses.
Investigations have uncovered irregular payments made by dishonest health facilities targeting SHA. Duale said the exact financial exposure will be determined once an ongoing validation exercise is concluded. “Preliminary estimates of financial exposure related to these irregular payments are in the range of several hundred million shillings,” he told senators.
The CS credited the detection to new digital safeguards embedded within SHA’s upgraded system, powered by Artificial Intelligence (AI) and machine learning. The tools identify abnormal claim patterns, inflated billing, and duplicate submissions in real time, ensuring that only biometrically verified beneficiaries are reimbursed.
“This ongoing forensic validation proves the effectiveness of SHA’s new system in uncovering and preventing fraud,” Duale said, warning that facilities implicated in the scam will face closure and prosecution. He confirmed that arrests and prosecutions will begin soon.
To boost transparency and accountability, SHA has also introduced an e-procurement platform to reduce human interference in tender evaluations and ensure compliance with the Public Procurement and Asset Disposal Act, 2015. Additionally, the SHA board’s Audit and Risk Committee is overseeing financial management and integrity.
Responding to questions from senators, Duale added that the Linda Mama maternal programme has now evolved into Linda Jamii, covering broader household health needs. So far, over 558,000 indigent households and 22,000 teenage mothers have accessed free healthcare under the new framework.
“The government remains committed to protecting public health funds through technology-driven oversight and strict accountability measures,” Duale affirmed.
