Govt rejects Ksh10.6B SHA claims due to fraud
The Ministry of Health vehemently rejected fraudulent and non-compliant medical claims amounting to Ksh10.6 billion, in what the Cabinet Secretary Aden Duale has described as a critical step in the government’s ongoing anti-fraud campaign within the national health sector.
In a press release on the ministry’s X account on Monday, August 25, 2025, Duale reaffirmed the ministry’s commitment to protecting public resources under the flagship TaifaCare universal health coverage program.
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“These claims were found to violate Section 48(5) of the Social Health Insurance Act, 2023, which outlines penalties for providers who knowingly or fraudulently alter information to defraud the Authority. Our position on safeguarding public resources has been consistent, clear, and unwavering. Fraud has no place in our health sector
The crackdown is part of a wider effort to enforce integrity and transparency in the implementation of the Social Health Insurance Fund (SHIF), a central pillar of TaifaCare, which was rolled out on October 1,2024, to ensure that every Kenyan has access to affordable and accountable healthcare.
Breakdown of claims
Duale said since the program’s inception, the Social Health Authority (SHA) has been handling an overwhelming volume of claims submitted by health facilities.
According to the latest data, health facilities have submitted claims totalling Ksh82.7 billion, of which Ksh53 billion has already been paid out.
Claims amounting to Ksh6.4 billion have been approved and are currently awaiting payment, while an additional Ksh7.6 billion in claims for August 2025 are still under review.
In addition to the Ksh10.6 billion rejected for fraudulent or non-compliant documentation, the ministry disclosed that Ksh3 billion worth of claims are under re-evaluation due to missing documents, while two billion shillings in claims have been flagged for surveillance and further investigation.
The CS explained that this meticulous review process is part of the SHA’s mandate under Section 35(2) of the Social Health Insurance Act, 2023, which empowers the Claims Office to validate claims, conduct quality assurance, and investigate irregularities.
The Ministry’s anti-fraud drive is rooted in constitutional and fiscal responsibility. Citing Article 43(1)(a) of the Constitution, which guarantees every Kenyan the right to the highest attainable standard of health, the CS emphasised that this right must be protected by ensuring that every public shilling is directed toward legitimate, life-saving services.
“Every shilling contributed to the Social Health Insurance Fund must go towards legitimate, life-saving healthcare,” the CS said.
Duale scoffs at critics
To reinforce public confidence in the health system, the Ministry has adopted an open data policy by continuously publishing the list of all health facilities paid for by the SHA.
“We continuously publish the list of all health facilities paid by the Social Health Authority (SHA), even though we aren’t legally required to. This public-facing approach ensures the public can hold us and healthcare providers accountable,” the CS explained.
The ministry also addressed growing concerns from social media users and professional associations, some of whom have questioned the timing and impact of the anti-fraud campaign. In response, the CS clarified that the crackdown is not a new initiative or a reaction to recent criticism.
“The concerns now being raised are not new; they have been an integral part of our public discourse and enforcement actions from the very beginning,” the statement read.
MOH affirmed that it will continue strengthening surveillance, auditing, and claim validation mechanisms through SHA, as mandated by law. Healthcare providers are being put on notice that any attempt to manipulate or falsify claims will be met with legal consequences.
