Health Cabinet Secretary Aden Duale has revealed that the government has intensified its crackdown on fraud in the healthcare system through the deployment of an advanced artificial intelligence (AI)-driven monitoring platform.
Appearing before the Senate plenary, Duale said the technology is already yielding results, having identified and blocked dozens of individuals involved in fraudulent activities within the Social Health Authority system.
“The technology has already identified and locked out 22 doctors and over 40 clinicians who were implicated in fraudulent activities,” Duale told senators.
According to the CS, the system has uncovered widespread abuse involving not only healthcare providers but also patients, exposing a complex web of collusion that has been draining public health funds.
“The collusion is among patients, health facilities and healthcare workers,” he said.
Duale disclosed shocking cases flagged by the system, including instances of patients manipulating records to make multiple claims within extremely short periods.
“An example that we have picked this week from the system; we found a patient who has gone to hospital five times in one day. In the morning he had an ear problem, at midday he had a stomach problem,” Duale said, illustrating the scale of fraudulent claims.
In another alarming revelation, the CS said the system detected individuals registering exaggerated numbers of dependants in order to exploit the system.
“We have found men claiming to have 50 spouses as dependants,” he said.
In what he described as one of the most extreme cases, Duale said the AI system flagged a patient who had listed hundreds of dependants.
“In perhaps the most extreme case, the system flagged a person alleging to have 375 children,” he added.
Duale said the government has taken decisive action against institutions found culpable, noting that several facilities have already been shut down.
“Twelve hospitals were formally closed on April 4 following forensic audits, and hundreds more are under investigation,” he said.
The Directorate of Criminal Investigations, Directorate of Criminal Investigations (DCI), is currently probing at least 250 health facilities, with 18 already facing court proceedings over fraudulent practices.
Some of the common fraudulent schemes uncovered, include “upcoding”-where facilities bill for more expensive services than those provided-converting outpatient cases into inpatient admissions, and filing claims for non-existent patients.
The government has already rejected more than Sh10.6 billion in fraudulent claims, signalling the scale of the problem within the system.
Duale maintained that the introduction of AI-driven monitoring tools marks a turning point in restoring integrity within Kenya’s healthcare sector.
“This robust AI system is strengthening accountability and ensuring public funds are used appropriately. It is a significant step toward transparency and integrity in our health system,” he said.
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