The Ministry of Health has intensified its crackdown on fraudulent activities in the healthcare sector, with Cabinet Secretary for Health warning that hospitals, doctors, and individuals found guilty of fraud will face the full force of the law.
Speaking at Afya House on Monday, CS Duale said billions of shillings meant for patient care have been lost to false claims, ranging from billing for non-existent patients to inflating treatment costs.
“Every shilling in the Social Health Insurance Fund must go to saving lives, not lining pockets,” the CS said, stressing that transparency and accountability remain at the heart of the Taifa Care program.
According to ministry data, health facilities have so far submitted claims worth KSh 91.7 billion. Of this, KSh 60.7 billion has been paid, KSh 6.4 billion approved and awaiting disbursement, while fraudulent or non-compliant claims worth over KSh 10 billion have been rejected.
Another KSh 5.1 billion is under review or investigation.
Several facilities have already been punished, including the suspension of 40 hospitals earlier this month, with a further 45 flagged for fraudulent activities.
Some were caught admitting patients who did not exist, converting outpatient visits into costly admissions, or even billing for multiple Caesarean sections on the same woman within days.
The ministry has also shut down 728 non-compliant facilities and downgraded 301 others since April. “This is a final warning. We are watching, and anyone involved in fraud will be prosecuted and forced to return stolen funds,” the CS warned.
On the NHIF legacy debt, the CS confirmed the government will honor verified claims up to KSh 10 million, with payments to be factored into the supplementary budget.
Larger claims, however, will undergo thorough verification before being settled.
The government has also teamed up with private insurers, including Jubilee, AAR, and Old Mutual, to form a joint anti-fraud taskforce.
The CS urged Kenyans to report suspicious activities through the toll-free number 147, saying citizen vigilance is key in protecting public money.
“Our fight has just begun,” he said. “We will not rest until every Kenyan can access quality, affordable healthcare free from the shadow of fraud.”
