45 Health Facilities Suspended Over Alleged SHA Fraud
By Chemtai Kirui, Nairobi,
The Ministry of Health has suspended 45 health facilities from the Social Health Authority (SHA) scheme over alleged fraudulent claims.
The suspensions were announced in a Gazette Notice dated August 26, signed by SHA Chief Executive Officer Dr. Mercy Mwangangi, invoking powers under Section 48(6) of the Social Health Insurance Act, 2023.
“In exercise of the powers conferred by section 48(6) of the Social Health Insurance Act, 2023, the Social Health Authority hereby gives notice to the public of the suspension of the health facilities set out in the Schedule below.” Dr Mwangangi said
“In accordance with the provisions of the Social Health Insurance Act, the health facilities set out in the Schedule shall not be entitled to any benefit from the Social Health Authority during the period of their suspension.” Mwangangi added.
The notice did not specify how long the suspension will last.
The suspended facilities are spread across at least 17 counties, with Mandera recording the highest number. Other affected areas include Homa Bay, Kisii, Kisumu, Garissa, Kakamega, Bungoma, Narok, Migori, Meru, Kirinyaga, Nandi, Kajiado, Uasin Gishu, Nairobi, and Busia.
This latest action follows earlier suspensions of 40 other facilities under the same legal provisions.
According to the Health Cabinet Secretary Aden Duale, the Social Health Authority (SHA) has so far received claims worth KSh 91.7 billion. Out of this, KSh 60.7 billion has been disbursed, while a further KSh 6.4 billion has been approved and is awaiting payment.
An additional KSh 5.1 billion in claims is still under re-evaluation.
He said that the Social Health Insurance Act provides a legal framework for tackling fraudulent conduct. Section 48 of the Act stipulates that service providers found guilty of falsifying claims or abusing the system may face fines, imprisonment, and permanent removal from the SHA system.
Duale cited rampant malpractices in the health insurance sector, including falsified clinical records, phantom billing, inflated and upcoded claims, and misuse of outpatient fees.
He said the Ministry’s new digital claims system under the TaifaCare program will be instrumental in detecting and curbing such fraud.
“Fraudulent providers will face prosecution and permanent removal from the SHA system,” Duale added, urging the public to report suspicious activity through SHA’s toll-free line (147) or email.
He also dismissed claims that the Social Health Authority (SHA) had stopped publishing payments to health facilities.
Though not legally required, SHA continues to publish facility payments as part of its commitment to transparency. The official register of health facilities, maintained by the Kenya Medical Practitioners and Dentists Council (KMPDC), remains publicly accessible.
“SHA continues to publish payments to health facilities as part of our firm commitment to transparency and the fight against fraud,” Duale said.
The Social Health Authority, established under the Social Health Insurance Act of 2023, replaced the National Health Insurance Fund (NHIF) in October 2024. It is mandated to deliver health insurance coverage to all Kenyans.
