- Health CS Aden Duale identifies five counties linked to widespread SHA fraud
- Counties named include Mandera, Kisii, Migori, Homa Bay and Wajir
- Fraud is mostly traced to private health facilities submitting fake claims
- SHA has already rejected KSh 13.2 billion worth of suspicious claims
- Dozens of hospitals were suspended, and several cases were handed to investigators
Health Cabinet Secretary Aden Duale has raised alarm over what he describes as deep-rooted fraud within the country’s health insurance system, pointing out five counties as major problem areas. Appearing before the Senate, he said Mandera, Kisii, Migori, Homa Bay, and Wajir have been identified as hotspots where irregular claims are repeatedly emerging. The revelations have sparked renewed concern over accountability in the management of public health funds.
According to Duale, most of the questionable claims are not coming from public hospitals but from private health facilities operating within those regions. He warned that the government will not tolerate continued abuse of the system meant to support patient care. The ministry, he added, is now tightening monitoring mechanisms to ensure only genuine claims are paid.
Duale further revealed that the Social Health Authority (SHA) has already blocked claims worth KSh 13.2 billion that were flagged as fraudulent. He said the system has been strengthened significantly since he assumed office, with major improvements in oversight and enforcement. The ministry has been using forensic tools and audits to detect suspicious transactions across hospitals.
He noted that when he took over the docket, fraud levels stood at around 26 per cent, but those numbers have now dropped sharply to below 6 per cent. The reduction, he said, is the result of aggressive action, including shutting down non-compliant facilities. More than 1,200 health institutions have already been closed as part of the crackdown.
The Health CS also confirmed that multiple fraud cases have already been escalated to law enforcement agencies. The Office of the Director of Public Prosecutions (DPP) has received at least 24 case files linked to SHA-related fraud, while the Directorate of Criminal Investigations (DCI) is handling over 80 files. Some of these cases involve senior officials, including former hospital executives.
He added that several files have already been reviewed and forwarded for prosecution, signalling that arrests and court actions are underway. According to him, the government is committed to ensuring that those implicated face legal consequences. He emphasised that accountability will not be compromised regardless of position or influence.
The crackdown on fraudulent activity has also led to the suspension of several hospitals across the country. Earlier this month, Duale announced the suspension of 12 health facilities after audits linked them to suspicious claims. The decision followed detailed forensic investigations carried out by SHA auditors.
Among the affected institutions are Bungoma West Hospital, Kerugoya Medical Centre, Baypharm Medical Centre, and Pro Elite Westlands and Specialist Hospital. Others include Calvary Hope Medical Centre, Umoja Three Medical Centre, and Shamberere Dispensary. The ministry says all these facilities will remain suspended until investigations are complete.
Duale insisted that the government’s main priority is to safeguard public resources meant for healthcare delivery. He said any funds lost through fraud directly affect ordinary citizens who depend on affordable medical services. The ministry, he added, will continue strengthening oversight systems to close loopholes.
He also stressed that reforms within the health sector are ongoing and will not slow down despite resistance from some players. According to him, the goal is to build a transparent and accountable system that serves all Kenyans fairly. The crackdown, he concluded, is far from over as more investigations continue across the country.
