Bungoma, Wajir Among Counties Leading in SHA Fraud – Duale

Bungoma, Wajir Among Counties Leading in SHA Fraud – Duale

Health Cabinet Secretary Aden Duale has flagged several counties as hotspots in an escalating fraud scandal involving the Social Health Authority (SHA), as the government intensifies a nationwide crackdown on false medical claims.

Speaking in Garissa on Saturday, April 4, Duale identified Homa Bay, Bungoma, Mandera, Wajir, and Kisii as the counties recording the highest number of suspicious claims, most of which are linked to private health facilities.

“Already, five counties – Homa Bay, Bungoma, Mandera, Wajir and Kisii – have been flagged for suspicious medical claims, largely from privately owned facilities,” Duale said.

The revelations come amid growing concern over systemic abuse of the national health insurance framework, with authorities uncovering widespread irregularities that have reportedly cost taxpayers billions of shillings.

According to the Health Ministry, at least 12 medical facilities have been shut down since March 30 alone as part of enforcement efforts aimed at curbing fraud within the system. In addition, 24 facilities are currently undergoing forensic audits, while 250 others are under active investigation by the Directorate of Criminal Investigations (DCI).

Duale revealed that legal action is already underway against several institutions implicated in the scheme.

“So far, 30 case files have been forwarded to the Office of the Director of Public Prosecutions, and 18 facilities are in court. In total, over 1,000 facilities have been closed,” he stated.

Investigations have uncovered a range of fraudulent practices, including inflated billing, submission of claims for services not rendered, and possible collusion between healthcare providers and insiders within the SHA system.

Sources familiar with the probe indicate that some facilities systematically manipulated billing records to maximise reimbursements, exploiting weaknesses in oversight mechanisms. In certain cases, patients were allegedly listed as having received treatments they never underwent.

The five counties flagged by the ministry are now under heightened scrutiny, with auditors focusing on abnormal billing patterns, unusually high claim volumes, and repeated submissions that raise red flags.

Among the facilities affected by the crackdown is Bungoma West Hospital, which was suspended from the SHA provider panel on March 30 over suspected fraudulent claims. The suspension is expected to last 90 days pending further investigations.

Other facilities cited in the ongoing probe include Baypharm Medical Centre in Homa Bay, Dawida Annex Hospital Ltd in Taita Taveta, Kerugoya Medical Centre in Kirinyaga, Raycos Health Centre in Mombasa, Calvary Hope Medical Centre in Bungoma, Shamberere Dispensary in Kakamega, Kurafa Medical Centre in Kiambu, Umoja Three Medical Centre in Nairobi, and The Pro Elite Westlands General and Specialist Hospital Ltd in Nairobi.

Health sector analysts warn that the scale of the fraud points to deeper structural challenges within the system, including inadequate monitoring, weak enforcement, and potential insider complicity.

The government has pledged to strengthen oversight mechanisms, enhance digital tracking of claims, and tighten accreditation requirements for health facilities participating in the SHA programme.

“We will not allow a few individuals to undermine a system designed to deliver affordable healthcare to millions of Kenyans,” Duale emphasized.

The crackdown comes at a critical time as the government seeks to expand access to universal healthcare, with SHA positioned as a cornerstone of the reform agenda.

As investigations continue, authorities have urged healthcare providers to adhere strictly to ethical and legal standards, warning that those found culpable will face severe penalties, including prosecution and permanent exclusion from the programme.

The unfolding scandal is expected to trigger broader reforms within Kenya’s healthcare financing system, as the government moves to restore public confidence and safeguard resources intended for essential medical services.

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Bungoma, Wajir Among Counties Leading in SHA Fraud – Duale