Duale: SHA to detect and flag fraudulent claims
Health Cabinet Secretary Aden Duale has warned health facilities against attempting to defraud the Social Health Authority (SHA), noting that the new system has robust mechanisms to detect, flag, and prevent fraudulent claims.
Speaking during an interview with a local TV station on Wednesday, January 28, 2026, Duale dismissed what he termed “sensational reporting” about the new health insurance system.
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“Screaming headlines sell. If you say SHA is working, it will not sell, but screaming headlines will get out of the shell,” he said.
The CS revealed that the government has already rejected Ksh11.6 billion in fraudulent claims submitted by health facilities nationwide.
According to Duale, the rejected claims came from both public and private health facilities.
“As of this evening, we have rejected 11.6 billion fraudulent claims. We can tell you about different health facilities, both private and public. Facilities made claims, and the system picked and went through different valuations and clinical reviews, and we are not paying.”
He explained that most fraudulent claims were detected during the initial transition from NHIF to SHA, when some facilities that had previously exploited the old system attempted to do the same under the new framework.
“So many of the fraudulent facilities that have milked NHIF since independence migrated to SHA, but little did they know the system has changed,” he said.
Duale assured Kenyans that the SHA system is designed to protect public funds and ensure accountability in healthcare financing.
“I want to make it clear to the people of Kenya, moving forward, every coin of a Kenyan he has paid for his health care insurance, if you steal it, the system will detect you, flag you, and the government will prosecute you.”
SHA Audit
This comes after an audit by the Ministry of Health revealed that the country lost Ksh11 billion through fraudulent claims submitted to the Social Health Authority (SHA).
The audit, conducted between October 2024 and April 2025, found that most of the fake claims originated from private hospitals operating under the Universal Health Coverage (UHC) scheme.
Speaking to a local newspaper, Health Cabinet Secretary Aden Duale said the government is seeking to recover the lost funds through the reimbursement system.
The audit revealed that some health facilities falsely converted outpatient services into inpatient admissions to claim higher payouts from the National Health Insurance Fund (NHIF), which SHA replaced in 2024.
Other facilities billed for services that were never rendered, inflated charges for the same procedures, or reported unusually high numbers of caesarean sections, far above World Health Organisation (WHO) thresholds.
