We'll not settle Sh12.7bn fake SHA claims - CS Duale

Health CS Aden Duale at Garissa High School /STEPHEN ASTARIKO

Health CS Aden Duale has a  word with Garissa township MP Dekow Mohamed /STEPHEN ASTARIKO

Wajir South MP Mohamed Adow speaking /STEPHEN ASTARIKO

The Ministry of Health will not settle fraudulent claims amounting to Sh12.7 billion flagged across health facilities countrywide, Cabinet Secretary Aden Duale has said.

Speaking at Garissa High School on Saturday during a ceremony to award winners of a Qur'an competition from Garissa county, Duale said the government was determined to safeguard public funds and ensure that money meant for patients is not lost through fraud.

“As a ministry, we will not pay claims worth Sh12.7 billion across all facilities, be they private, public, faith-based, and even our referral hospitals that come under the Ministry of Health. We will do whatever it takes to protect public resources and money meant for patients,” he said.

He revealed that the Directorate of Criminal Investigations is probing more than 1,200 health facilities over suspected fraudulent activities linked to the claims.

The CS used the occasion to praise the Social Health Authority, saying the new health insurance system had played a critical role in flagging and rejecting suspicious claims that would otherwise have been paid under the defunct National Hospital Insurance Fund.

On Friday, while appearing before senators in Naivasha, Nakuru county, Duale strongly dismissed allegations that Sh11 billion had been looted from SHA.

Instead, he clarified that the Sh12.7 billion figure represents claims that were flagged, rejected, and remain unpaid by the system’s digital verification platform.

“So, these are monies that we have saved. These are monies that if NHIF was in place today and was using the manual system, this money could have been paid to providers,” he said.

Duale further told senators that private facilities account for the largest share of the flagged claims at 59 per cent, translating to Sh7.4 billion. County facilities follow at 21 per cent, amounting to about Sh2.6 billion. Faith-based facilities account for 11 per cent or Sh1.4 billion, while national referral hospitals recorded the least cases.

He disclosed some of the methods allegedly used to defraud the system.

“You have a situation where 500 claim forms are filled by one person with the same handwriting and one biro. That is fraud, and we will not accept,” he said.

“Second, and more importantly, there are facilities that are reporting that they are claiming for 300 maternity reimbursements, and all of them are C-sections. That is against WHO guidelines.” 

The revelations come amid an ongoing dispute between healthcare providers and the Ministry of Health over delayed and unpaid claims under SHA. While the government maintains that the transition from NHIF to SHA introduced structural, administrative, and operational reforms aimed at strengthening healthcare financing and advancing universal health coverage, some hospitals argue that the shift has been marred by reimbursement delays that have strained service delivery.

Despite the concerns raised by providers, Duale maintained that the reforms are necessary to seal loopholes, curb fraud, and restore public confidence in the country’s health insurance system.