A forensic audit has exposed a massive looting syndicate within the healthcare sector, with the Social Health Authority (SHA) blocking Sh11 billion in fraudulent claims filed by private hospitals in just six months.

Health Cabinet Secretary Aden Duale revealed the staggering scale of the theft, describing it as "financial terrorism" against the sick.The audit, covering the transition period from October 2024 to April 2025, uncovered a litany of creative accounting tricks used by facilities to bleed the public purse. From billing for "ghost patients" to performing unnecessary C-sections to inflate invoices, the rot runs deep.

The Methods of Theft

The findings read like a manual on white-collar crime. Private hospitals, which account for the bulk of the flagged claims, were found to be upcoding procedures—billing for complex surgeries when only basic treatment was given. In some egregious cases, facilities submitted claims for patients who were not even in the country.

"This is when the real theft took place," Duale told the *Daily Nation*. "They thought the transition from NHIF was a window of chaos they could exploit. They were wrong."

• The Crackdown: The Ministry has handed over 1,188 files to the Directorate of Criminal Investigations (DCI). These files implicate 24 facilities with "conclusive evidence" of fraud.
• The Recovery: The government is not just stopping at arrests; it is clawing back the money. The stolen billions will be deducted from future reimbursements, a move that could bankrupt the complicit hospitals.

A System Under Siege

The scandal highlights the existential threat facing Kenya's Universal Health Coverage dream: corruption. If Sh11 billion can be siphoned off in six months, the sustainability of the entire fund is in question. Duale’s aggressive stance has won praise, but it also pits him against a powerful medical lobby.

The message is stark: the SHA will not be the cash cow that the NHIF was. By tightening the digital dragnet, the state is trying to ensure that health funds pay for medicine, not the mansions of unscrupulous hospital owners.