An audit by Kenya's Ministry of Health has revealed that the Social Health Authority (SHA) lost Sh11 billion due to fraudulent claims, primarily from private hospitals operating under the Universal Health Coverage (UHC) scheme. The government plans to recover these funds.

• The audit, conducted between October 2024 and April 2025, found that hospitals falsely converted outpatient services to inpatient admissions for higher payouts and billed for services never rendered.
• Health Cabinet Secretary Aden Duale handed over 1,188 case files to the Directorate of Criminal Investigations (DCI) last September, citing widespread fraud including upcoding and phantom billing.
• Of these, 190 files involved 24 facilities with conclusive fraud evidence, 61 under investigation, and 105 closed by the Kenya Medical Practitioners and Dentists Council (KMPDC).
• The SHA has flagged over Sh10.6 billion in fraudulent claims, resulting in over 40 facilities suspended and at least 31 hospitals shut down.