Nairobi: The Ministry of Health has suspended 40 health facilities across the country over widespread fraudulent claims to the Social Health Authority (SHA), in what Cabinet Secretary for Health, Aden Duale, described as a 'grave threat' to the sustainability of Kenya's universal health coverage agenda.
According to Kenya News Agency, the suspensions, announced at Afya House and published in Kenya Gazette No. 168 of August 7, 2025, follow a month-long forensic audit by SHA's Digital Health System, which flagged suspicious claims. The CS said the review uncovered multiple fraudulent practices, including upcoding, claiming for more expensive procedures than those performed, falsification of records, submitting altered medical information to inflate claims, and conversion of outpatient visits to inpatient care.
Other fraudulent activities identified were billing for services patients deny receiving, multiple billing, and ghost patients, including collusion between facilities to claim for the same patient. The facilities implicated span across various counties, including Nairobi, Bungoma, Homa Bay, Mandera, Kilifi, among others.
The Ministry has also withdrawn SHA platform access rights from eight doctors and four clinical officers linked to the fraud and forwarded their names to the Directorate of Criminal Investigations (DCI) for prosecution. Regulatory bodies such as the Kenya Medical Practitioners and Dentists Council and the Clinical Officers Council have been asked to begin disciplinary proceedings that could result in license cancellation for health practitioners found culpable.