Health Cabinet Secretary Aden Duale has committed to publicly naming all hospitals and firms implicated in Ksh11 billion in fraudulent claims rejected by the Social Health Authority’s (SHA) fraud detection system. He affirmed that these rejected claims, identified through forensic audits and professional review, will not be paid, emphasizing transparency and accountability in the health financing system.

• The Ksh11 billion in outstanding claims represents funds lost in just six months due to widespread manipulation of medical records and inflated billing.
• The SHA's AI-driven fraud detection system flagged impossible medical scenarios, such as private hospitals reporting 100 percent caesarean section deliveries.
• CS Duale revealed instances like a hospital in Tharaka Nithi County claiming all 500 mothers who delivered underwent C-sections, and one patient in Kwale County registering 381 dependent children.
• The Auditor General Nancy Gathungu also found that a private consortium, potentially linked to an Indian firm, controls the Ksh104 billion SHA system, but the Kenyan government does not fully own it.
• The SHA has given hospitals a 15-day ultimatum to account for Ksh3 billion flagged for missing documentation or potential fraud.

The Directorate of Criminal Investigations (DCI) and the Kenya Medical Practitioners and Dentists Council (KMPDC) have initiated a crackdown on unlicensed health facilities in Nairobi, leading to arrests and investigations into malpractice.

• Two suspects were arrested in Kawangware, Dagoretti, for operating an unlicensed medical centre.
• The crackdown follows a recent case where Amos Isoka, from Kawangware, died after an alleged botched dental procedure at an unlicensed clinic.
• KMPDC is also investigating a private hospital in Umoja II estate after an eight-month-old baby reportedly lost a finger during a routine medical procedure.