Audit Reveals Over Sh10 Billion Lost in SHA Fraud
Health Updated: 28 January 2026 21:27 EAT
Health Cabinet Secretary Aden Duale responding to audits in his ministry
An audit has uncovered massive financial losses at Kenya’s Social Health Authority (SHA), revealing that more than Sh10 billion was lost through fraudulent and irregular medical claims, triggering renewed concern over accountability in public healthcare financing.
The losses were recorded within months of the rollout of SHA, which replaced the National Hospital Insurance Fund as part of reforms aimed at delivering universal health coverage.
Audit findings indicate that a large share of claims submitted by healthcare providers were either inflated, unsupported by medical records, or linked to services that were never rendered.
Health sector officials disclosed that preliminary assessments put the value of the irregular claims at about Sh11 billion, with the majority flagged during internal verification processes.
The audit points to widespread abuse by some hospitals and clinics, both private and public, that took advantage of weaknesses in the claims processing system.
Among the most common red flags were unusually high volumes of specialised procedures, including caesarean sections and surgeries, reported by certain facilities at levels far above national norms.
Investigators also identified cases of duplicate billing, where the same patient was claimed for multiple times, as well as claims submitted for non-existent or ghost patients.
In several instances, facilities sought reimbursement for services outside their approved accreditation, in violation of SHA regulations.
The audit further revealed serious documentation gaps, with many claims lacking mandatory supporting evidence such as treatment notes, diagnostic results, or referral records.
Government officials maintain that the exposure of the fraud demonstrates the effectiveness of the new SHA oversight mechanisms, noting that many of the suspicious claims were detected before payments were completed.
However, the scale of the attempted fraud has raised questions among lawmakers and oversight bodies about the robustness of controls during the early implementation phase.
In response, the Ministry of Health has announced plans to suspend facilities implicated in fraudulent activities and to pursue recovery of lost public funds.
Cases deemed criminal are expected to be forwarded to investigative agencies, as authorities move to tighten controls and restore confidence in the country’s health insurance system.
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FELIX MAKONA
FACT FINDER AND DATA DRIVEN JOURNALIST. DATA MINING AT IT'S BEST. GET FACTS RANGING FROM MATTERS DISABILITY AND INCLUSION, POLITICS, ECONOMY, SPORTS AND GENERAL NEWS AROUND THE WORLD