BREAKTHROUGH AS GOVT CURBS FRAUDULENT SHA CLAIMS WITH NEW HEALTH SYSTEM

The government has intensified its crackdown on fraudulent Social Health Authority (SHA) claims, with the new digital health system exposing widespread malpractice among health facilities.
According to the Digital Health Agency (DHA), which oversees the centralized system established under the Digital Health Act, 2023, forensic audits have revealed large-scale fraud involving false patient data, ghost admissions, and inflated billing.
As a result, at least 85 facilities have been suspended in recent weeks, including 40 flagged in the latest audit. Earlier, 31 private hospitals were suspended for overstating bed capacity and misusing pre-authorization codes.
By August, authorities had shut down 983 non-compliant facilities and downgraded 487 others. Investigators also uncovered more than three million fraudulent entries inherited from the former NHIF system.
The crackdown has had significant financial implications. SHA reports show that claims worth KSh 10.6 billion have been rejected, while another KSh 3 billion remain under review and KSh 2.1 billion have been flagged for closer scrutiny.
The agency has also submitted 1,188 fraud investigation files to the Directorate of Criminal Investigations (DCI) for possible prosecution.
Health officials say the move is part of wider reforms to restore public trust in the new universal health coverage scheme.