The Ministry of Health has come under renewed public scrutiny following revelations that at least Sh11 billion was lost through fraudulent claims at the Social Health Authority (SHA) within a period of just six months.
Health Cabinet Secretary Aden Duale disclosed the scale of the losses while appearing before Members of the National Assembly during a retreat held in Naivasha, Nakuru County, where he detailed how the funds were siphoned between October 2024 and April 2025.
According to the CS, the money was lost through a network of fictitious surgeries, exaggerated medical claims and manipulated patient records, allegedly involving both private health facilities and insiders within the SHA system.
Despite the rollout of what the ministry had previously described as a “tight and secure” digital claims management system, Duale told legislators that fraudsters quickly found new ways to exploit the platform.
“We are dealing with organised and sophisticated abuse of the system,” Duale said, adding that some of the claims were processed with the help of SHA-authorised medical personnel.
One of the most alarming trends, according to the Health CS, is the sharp rise in questionable surgical claims, particularly involving maternity services.
Duale told MPs that some hospitals had been submitting unusually high numbers of caesarean section claims, far beyond medically acceptable levels.
“In maternity services, we have facilities claiming that almost all deliveries were through C-section. This clearly goes against global medical standards,” he said.
He further revealed that in some cases, expectant mothers were allegedly being pushed into surgical procedures that were not medically necessary, solely to increase the value of insurance claims submitted to SHA.
“Somebody wants to force a mother to undergo a C-section when she can deliver normally just because they want to get a difference of about Sh20,000,” Duale said.
The issue sparked sharp reactions from legislators present at the meeting, with National Assembly Speaker Moses Wetang’ula expressing concern over what he described as the growing commercialisation of childbirth.
“We used to see doctors tell mothers to push during birth. Nowadays it is just go to theatre. We want to go back to ‘sukuma’,” Wetang’ula remarked.
Duale went on to reveal that several of the reported surgical procedures were later found to be entirely fictitious.
He cited the case of one health facility that submitted dozens of claims for caesarean deliveries, only for investigators to discover that the hospital had no functional operating theatre.
“We have one facility that told us they are doing C-sections, and when I visited, it had no theatre, yet it had 35 claims of C-sections,” Duale said.
Beyond maternity-related fraud, the CS disclosed widespread manipulation of patient records and dependent data, which he said had opened another major channel for looting public health funds.
In one particularly striking case in Kwale County, Duale revealed that a single patient record showed an impossible number of dependents.
“There is a patient in Kwale County whose dependent children are listed as 381. We are handing over that case to the DCI,” he told lawmakers.
According to the Health CS, many of the fraudulent claims were supported by documentation that appeared to have been filled by the same individuals across multiple facilities, raising serious concerns about internal collusion.
The scandal has triggered a nationwide crackdown on facilities and health workers suspected of abusing the SHA system.
Duale told the National Assembly that the ministry has already taken administrative action against dozens of medical professionals.
“We have deregistered 22 doctors and 36 clinical officers from the SHA platform. We have also closed down 1,118 health facilities,” he said.
He added that the ministry has submitted more than 1,000 case files to the Directorate of Criminal Investigations (DCI) for further probe.
The revelations prompted MPs to demand clearer accountability and faster criminal investigations into the massive losses.
Mwingi West MP Charles Nguna pressed the ministry to reveal the number of arrests made so far.
“How many people have been arrested in connection with the cases you have mentioned?” Nguna asked.
In response, Duale said that while administrative action had been taken, the criminal investigations were still ongoing.
“DCI has promised to go after those who stole,” he said, but acknowledged that progress in concluding the cases had been slower than expected.
The latest disclosures have cast doubt on the effectiveness of the digital safeguards that were introduced to protect worker contributions under the new Social Health Authority framework, which replaced the former National Hospital Insurance Fund (NHIF).
The SHA system had been presented as a major reform intended to seal corruption loopholes, improve transparency and guarantee better healthcare access for Kenyan households.
However, the Sh11 billion loss in just six months has raised fresh concerns about whether the current controls are sufficient to protect public funds.
Despite the unfolding scandal, the Ministry of Health maintained that the overall rollout of the SHA programme had recorded positive progress.
Duale told legislators that more than 29 million Kenyans have already registered on the SHA platform, describing the uptake as encouraging.
Still, the growing list of fraudulent claims, deregistered medics and closed health facilities is expected to intensify public pressure on the government to tighten oversight, strengthen internal controls and fast-track prosecutions.
As investigations continue, the ministry says the recovery of stolen funds remains a priority, even as Kenyans await clear answers on how such large-scale abuse was able to occur within a system that was designed to prevent exactly that.
