KISUMU, Kenya June 28,-Health Cabinet Secretary (CS) Aden Duale has issued a stern warning to certain healthcare facilities, workers, and patients involved in colluding to submit fraudulent claims against the Social Health Authority (SHA) Fund.
He stated that this rising practice is illegal, unethical, undermines efforts for universal healthcare, and ultimately harms every Kenyan.
Among the six serious issues flagged by the Ministry, one notable offence is the misrepresentation of claims.
Speaking at an Economic Empowerment forum for Kisumu County’s Bunge la Wananchi—organised by Kisumu 19 United Development CBO, which aims to purchase a welfare bus—CS Duale highlighted that some health facilities are fraudulently converting outpatient claims into inpatient claims.
“This is a serious offence. Any facility found engaging in this malpractice will be shut down immediately and prosecuted. So far, we have closed 35 hospitals due to malicious claims,” he stated at Tom Mboya Labour College earlier today.
Duale further explained that in these facilities, health workers are coercing patients into unnecessary admissions to increase claim values.
Legal Action
He urged health workers to adhere to professional medical ethics and the law, warning that both individual practitioners and facility owners would face legal actions for their misconduct.
In some cases, patients have been found colluding with health facilities by sharing their access codes to file claims for services that were never rendered.
Duale cautioned that this constitutes criminal fraud and that any patient, doctor, or facility involved will be prosecuted to the fullest extent of the law.
Doctors who misuse pre-authorisation codes to defraud the Fund will also face prosecution.
Other fraudulent activities that could lead to immediate closures include the admission of “ghost” patients—individuals who do not exist or exceeding the facility’s physical capacity to accommodate patients.
He condemned the practice of some health facilities demanding cash payments from patients while also billing the SHA Fund for the same services.
CS Duale encouraged patients to report such incidents by contacting the SHA Call Centre at 147.
The event was attended by Energy and Petroleum CS Opiyo Wandayi, National Assembly Majority Leader Kimani Ichungwa, and Principal Secretary for Children’s Welfare Carren Agengo, along with President’s Personal Aide Faruk Kibet, Kisumu Woman Rep. Ruth Odinga, Kisumu Deputy Governor Dr. Mathew Ochieng Owili, and several area MPs and MCAs.
“We will not hesitate to take strong and swift action against any individual or institution found guilty,” Duale concluded.
