A Ministry of Health audit has revealed that the Social Health Authority (SHA) lost Sh11 billion to fraud between October 2024 and April 2025, with private hospitals submitting the majority of fake claims.

The reported fraud included falsifying patient records, phantom billing, inflating costs, and converting less expensive outpatient visits into costly inpatient claims. In maternity services, some hospitals falsely claimed all deliveries were C-sections.

In response to the audit, CS Duale announced the suspension of 40 health facilities from the SHA program and submitted 1,188 fraud case files to DCI and other regulatory bodies for further investigation and prosecution.

The ministry is in the process of recovering the fraudulently claimed funds from the involved facilities and has adopted an AI-powered fraud detection system to monitor and block suspicious claims in real-time.

• DAILY NATION