Kenya’s health ministry has uncovered widespread fraud in the country’s new national health insurance system, the Social Health Authority (SHA), with authorities estimating losses of more than €71 million.
The funds were allegedly stolen, misused or obtained through fraudulent reimbursement claims submitted by hospitals and clinics nationwide, the ministry said.
The SHA was launched to replace the former National Hospital Insurance Fund (NHIF) as part of reforms aimed at expanding healthcare coverage and improving access to services.
However, within months of its rollout, the scheme has been hit by a credibility crisis after investigations linked hundreds of healthcare facilities to false claims.
Officials said probes uncovered fictitious medical procedures, inflated billing and the registration of “ghost patients”. Artificial intelligence systems flagged abnormal patterns, including one insured person listed with 381 dependants in Kwale County.
As a result, more than 1,100 health facilities have been suspended or shut down, while criminal investigations are ongoing. Health Minister Aden Duale said enhanced audits had blocked irregular claims worth billions of shillings and warned that perpetrators would face prosecution.
In parliament, Nairobi legislator Esther Passaris called for greater transparency, saying the lost funds could have been used to improve hospital infrastructure, supply medicines and support healthcare workers.
The government said the Taifa Care programme, a central pillar of its universal health coverage policy, would continue, with tighter controls introduced to restore public confidence.
