By Ongaga Ongaga
The government has suspended 45 health facilities across the country after uncovering widespread fraud and malpractice within the Social Health Authority (SHA) system.
The decision, published in a special issue of The Kenya Gazette on Tuesday, was made under Section 48(6) of the Social Health Insurance Act, 2023, effectively barring the affected facilities from accessing any SHA benefits during the suspension period.
The facilities, spread across counties such as Kisii, Meru, Kirinyaga, Homa Bay, Garissa, Mandera, Kajiado, Uasin Gishu, Nairobi and Kakamega, include both small clinics and well-known hospitals.
Among those named are Equity Afia branches in Homa Bay and Mandera, Guardian Hospital in Meru, Kimathi Medical Services in Kirinyaga and Northgate Hospital in Garissa.
Others are Lenmek Hospital in Kisii, Neocare Memorial Hospital in Migori, Novic Medical Centre in Nairobi, Palmcare Sinai Hospital in Uasin Gishu and The Tranquil Hospital in Kakamega.
This move comes just weeks after 40 other facilities were suspended on August 7, bringing the total number of suspended health institutions in August alone to 85.
According to Health Cabinet Secretary Aden Duale, the crackdown follows forensic audits powered by a new digital system that uses artificial intelligence to detect fraudulent claims.
The audits revealed serious malpractices, including falsified medical records, billing for patients who never existed, inflating service costs and converting outpatient visits into inpatient admissions in order to draw more funds from the public health insurance scheme.
Duale disclosed that SHA has already rejected claims worth KSh 10.6 billion due to fraud or non-compliance.
“To all healthcare providers—consider this a final warning. Any facility, doctor or patient found to be involved in fraudulent activities will be held liable and face the full force of the law,” he warned.
The Social Health Authority, which replaced the National Health Insurance Fund (NHIF) late last year, was launched to expand universal health coverage and protect Kenyans’ contributions from misuse.
However, the sweeping suspensions highlight the scale of the challenge the new system is facing in curbing entrenched fraud in the health sector.
SHA Chief Executive Officer Dr. Mercy Mwangangi assured the public that the authority remains committed to transparency and has made a list of all facilities paid under the scheme accessible on its website.
She stressed that while the suspensions are disruptive, they are necessary to protect public funds and safeguard the integrity of the healthcare system.