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.

The Ministry of Health has announced the permanent absorption of 7,414 temporary Universal Health Coverage (UHC) staff, transitioning them to permanent and pensionable terms by September 2025. This decision follows a verification process aimed at streamlining healthcare services and achieving UHC goals.

• A total of 7,414 UHC staff will be absorbed, with only those in active service being eligible for the permanent roles.
• Health Cabinet Secretary Aden Duale confirmed the absorption and clarified that staff with pending disciplinary issues or those absent from duty will not be absorbed.
• The absorption process stems from a joint verification by the State Department for Medical Services and the Council of Governors (CoG), which identified 215 staff as ghost workers or unqualified.

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.