Nairobi: Health Cabinet Secretary Aden Duale has reiterated the government's steadfast position on safeguarding public resources, emphasizing a consistent and clear approach. Duale addressed a press conference to provide a comprehensive update on the ongoing fight against fraud and to respond to recent discussions from various professional associations, including those on social media.
According to Kenya News Agency, Duale highlighted that concerns raised are not new and have been integral to public discourse and enforcement actions from the outset. He emphasized the government's commitment to transparency by continuously publishing the list of health facilities paid by the Social Health Authority (SHA), enabling public accountability for both the government and healthcare providers. Duale warned healthcare providers involved in fraudulent activities of facing legal consequences and announced ongoing processes to recover misappropriated funds with law enforcement's involvement.
Since April, Duale noted an intensified fight against fraud with a comprehensive digital system designed to eliminate vulnerabilities previously affecting the defunct National Health Insurance Fund (NHIF). This system aims to detect fraud and flag anomalies at every stage of the claims process. Duale mentioned the closure of 728 non-compliant facilities and the downgrading of 301 facilities by the regulator, KMPDC, as part of the crackdown on malpractice.
Duale shared the current status of claims processing since the Taifa Care rollout on October 1, 2024. A total of Sh9 billion in claims have been submitted, with Sh7.7 billion paid, while the remaining balance awaits the next payment cycle. He added that for the Social Health Insurance Fund (SHIF), claims totaling Sh82.7 billion have been submitted to SHA, with Sh53 billion paid, and Sh6.4 billion approved but pending payment. Claims worth Sh10.6 billion were rejected due to fraudulent activities or non-compliance, under Section 48(5) of the Social Health Insurance Act, 2023.
Duale concluded by affirming the government's strategy to build a robust, corruption-proof system and collaborate with medical insurance companies through a Joint Anti-Fraud Action, ensuring access to quality, affordable healthcare free from fraud.