Mulembe Times | June 30, 2025
Dozens of hospitals in Kenya are under investigation for defrauding SHA of Ksh.100 million through false claims. CS Duale confirms 35 facilities have already been shut down.
In what is shaping up to be one of the most explosive healthcare corruption scandals in recent years, dozens of hospitals across the country have been implicated in a massive fraud scheme targeting the Social Health Authority (SHA).
An internal investigation report, obtained by Citizen TV, reveals that over 35 healthcare facilities, primarily Level 4 and Level 5 hospitals, have allegedly swindled the government out of nearly Ksh.100 million through falsified medical claims.
A Well-Coordinated Scam
According to the damning findings, rogue health workers in collusion with patients and facility administrators orchestrated a scheme involving:
- Converting outpatient visits into inpatient admissions
- Admitting patients unnecessarily or without proper documentation
- Registering ghost patients in already full wards
- Inflating the number of hospital beds to qualify for higher SHA reimbursements
The deception, according to officials, was enabled through the misuse of pre-authorization codes, which allowed healthcare workers to fraudulently file inpatient claims for services never rendered.
Whistleblowers within the affected facilities have provided detailed accounts to the Ministry of Health, exposing coercion, falsification of patient data, and collaboration with patients willing to share their personal SHA credentials in exchange for kickbacks.
Cabinet Secretary Aden Duale Speaks Out
Speaking from Kisumu County, Health Cabinet Secretary Aden Duale condemned the malpractice in the strongest terms possible.
“Wanafanya double claims. They have turned outpatient into inpatient. In fact, nimefunga hospitali karibu saba hapa Kisumu. Hii leo asubuhi nimefunga Bungoma, Busia, Kilifi, Mandera, Wajir, Kajiado — hospitali 35. Hatuwezi kubali utumie jina ya Wakenya,” said the CS.
CS Duale vowed that no rogue institution will be spared, promising to send files of the implicated facilities to the Directorate of Criminal Investigations (DCI) for immediate action.
“If you are a medical worker and you allow your pre-authorization code itumiwe kuibia pesa SHA… Kama wewe ni Mkenya na utumiwe na health facility ili wapore pesa ya SHA — kesho Monday I am sending a number of files of health facilities to DCI,” Duale declared.
Services Suspended, Licenses at Risk
A high-level source at the Ministry of Health confirmed that SHA has suspended services at several facilities across at least 10 counties pending further investigations.
The Kenya Medical Practitioners and Dentists Council (KMPDC) has also been drawn into the matter and is reportedly in the process of revoking licenses of both healthcare institutions and individual practitioners found complicit.
According to investigators, some hospitals were operating with as few as 14 beds but claimed to have over 100, inflating figures to siphon public funds illegally.
A Pattern of Recycling Corruption
The scandal has raised fresh concerns about the integrity of healthcare financing under SHA, which replaced the National Health Insurance Fund (NHIF) earlier this year. Critics say the scam reflects a recycled script of entrenched corruption in the country’s public sector, with fake patients, doctored records, and insider collusion.
Despite efforts to digitize and streamline healthcare claims, the use of manual overrides and staff-administered authorization codes has created loopholes ripe for exploitation.
Public Outrage and Government’s Response
Public outrage is growing as Kenyans question how such a significant fraud could occur so soon after SHA’s rollout. Many are demanding transparency from the Ministry and stronger systems to prevent future abuse of taxpayer funds.
The government, in response, has promised full transparency and disciplinary action. Investigations are ongoing, and CS Duale has promised that any facility or individual found guilty will face the full force of the law.
With files heading to the DCI and the KMPDC tightening the noose on errant professionals, the coming weeks could see arrests, court proceedings, and potentially the closure of dozens more hospitals. The scandal has also renewed calls for SHA to accelerate digitization, improve claim verification systems, and carry out regular audits of service providers.
