Duale: Health workers, medical facilities to blame for SHA's false claims

‎Health CS Aden Duale  answers questions on the floor of the Senate at the Chambers, Parliament on April 22,2026 [Elvis Ogina, Standard]

Health Cabinet Secretary Aden Duale has now pointed an accusing finger at some unscrupulous patients, healthcare workers and facilities, who have been attempting to defraud the Social Health Authority (SHA).

The CS regretted the multiple attempts that the Ministry of Health's digital systems have had to block significant fraudulent activities, which have helped in saving millions of shillings.

Duale made the remarks as he named Mandera, Kisii, Migori, Homa Bay, and Wajir counties as some of the major hotspots for alleged fraud linked to SHA claims, the majority of which are reported in private health facilities.

The CS was before the Senate plenary, where he dismissed reports indicating that billions have gone missing, saying that the frequent reference made to Sh12.7 billion represents claims flagged, rejected, and unpaid by the digital system.

Duale also told Senators of situations where the Health Digital system, including a man listed with 375 dependents and another found with over 50 spouses.

“I want to confirm to you that the people who are taken to court, the majority are from Wajir and Mandera. The people who have done out-of-court settlements and paid SHA, the majority of whom are also from that region, among other Kenyans. We don't want crooks and cartels who want to eat and who are used to eating at NHIF to continue doing the same business of fraud. SHA, unlike NH, is driven technologically,” the CS said.

He also referred to a situation where the Digital Health system identified a patient for having gone to a hospital five times in a day - in the morning, it was an ear problem and a stomach problem at midday.

According to the CS, the collision of fraud has been between some of the patients, health facilities and health care workers, noting that some 22 doctors have been denied access to the SHA and digital health system while over 40 clinicians have been denied their rights because of fraud, a move he said would continue.

“The Ministry officials found somebody who said his dependents are 375 children; there is a hospital in Bungoma where more than 400 children are born every month. I don't think there is somebody who has a dependence on 372 children, and that person is from Kwale, which the DCI is investigating,” he said.

In another situation, the CS said the Ministry found men who claim to have over 50 spouses as dependents.

“We have found men who claim to have over 50 and 70 spouses as dependents. So that is what is going on in Kenya in terms of fraud,” Duale stated.

At least 81 active cases are being investigated by the DCI and some 24 files have been forwarded to the Director of Public Prosecutions (DPP) for action.

The CS also told political leaders not to seek intervention when the Ministry takes enforcement measures against suspected fraudsters.

“When I close a hospital, don't call me! The facility owners should know that their political affiliations or "political parties will not help you" when facing enforcement for fraud. Even if a hospital is owned by a sitting Member of Parliament, it will be closed if found to be defrauding the public,” charged Duale.

Duale insisted that SHA is working well, even as he attributed constant criticism to "cartels" whose illegal dealings have been exposed by the new system.

At the same time, Duale informed the House of total pending claims for the defunct EduAfya Medical Scheme amounting to Sh735.8 million, which includes Group Life and last expense at Sh116 million, inpatient claims Sh320.5 million and outpatient claims at Sh299 million respectively.

Already, Sh116 million for the Group Life and Last expense have been settled with payments expected in two weeks, while the balance of Sh 619.8 million for both inpatient and outpatient is to be settled once the funds are available.

He said the remaining hospital claims will be systematically settled against the broader NHIF legacy debts upon the availability of funds, adding that the National Treasury has allocated Sh4billion in the Supplementary Budget for the settlement of claims for healthcare facilities with debts of less than Sh10 million.

Nairobi Senator Edwin Sifuna had sought answers on when the pending claims under the defunct EduAfya Medical Scheme would be settled.

“Why has the Government not paid last expense compensation to Norbert Bulungu, father of the late Miss Shekinah Pendo Vudavila, a student at Naivasha Girls Secondary School who died on 17th October, 2023, despite the claim having been lodged and when will the claim be settled?” Sifuna posed.

Duale explained that children are now covered as dependents under their parents' SHA insurance, which has replaced the EduAfya programme.