Health Cabinet Secretary Aden Duale has defended the Social Health Authority's (SHA) rejection of Sh10.6 billion in medical claims due to widespread fraud. This action is part of the government's intensified crackdown on healthcare fraud, with an additional Sh3 billion under re-evaluation and Sh2.1 billion under surveillance.

• The SHA has paid Sh53 billion and approved Sh6.4 billion in claims out of Sh82.7 billion submitted.
• The TaifaCare digital claims system, rolled out in October 2024, has detected irregularities like upcoding and phantom billing, leading to the shutdown of 728 non-compliant health facilities.
• Fraudulent providers will face prosecution and permanent removal from the SHA system, with the ministry recovering wrongfully paid funds.

Kenya's Ministry of Health has revealed a significant fraud scheme within the Social Health Authority (SHA), with Health Cabinet Secretary Aden Duale detailing widespread misuse of funds. The fraud, estimated globally at up to 15% of healthcare expenditures, has led to numerous facility closures and rejections of fraudulent claims worth billions of shillings.

• Ksh10.6 billion in claims have been rejected due to fraudulent activities or non-compliance, with a comprehensive digital system utilizing AI flagging irregularities.
• The crackdown has resulted in the closure of 728 non-compliant health facilities and the downgrading of 301 others by the Kenya Medical Practitioners and Dentists Council (KMPDC).
• Specific facilities, including Nabuala Hospital in Bungoma and Al-Masry Nursing Home in Mandera, were implicated for various fraudulent practices such as falsified medical records and phantom billing.