Multi-Billion Shilling Scandal Uncovered

A sprawling investigation into Kenya's newly established Social Health Authority (SHA) has exposed a massive fraud scheme, with detectives uncovering billions of shillings in fictitious claims, illegal payments to non-existent “ghost” hospitals, and widespread billing irregularities. The scandal, emerging just over a year after SHA's launch, has led to the suspension of dozens of health facilities, the arrest of several individuals including a former acting CEO, and a public outcry for accountability, severely undermining the nation's ambitious push for universal health coverage (UHC).

The multi-agency probe, which involves the Directorate of Criminal Investigations (DCI), is scrutinizing what Health Cabinet Secretary Aden Duale has described as a sophisticated racket. On Thursday, November 13, 2025 (EAT), the gravity of the situation continues to unfold. According to ministry reports, investigators are looking into a variety of fraudulent practices, including double billing, falsifying medical records, and billing for services never rendered. In one documented case, a health facility allegedly received Sh285,000 for a Caesarean section that never happened, as the patient had a normal delivery. Another hospital, licensed in February, received Sh12.2 million from the Social Health Insurance Fund (SHIF) between May and June for services it claimed to have provided.

Government Crackdown and Legal Action

In response to the escalating crisis, the Ministry of Health has taken decisive action. As of late 2025, the government has suspended at least 85 health facilities from the SHA scheme over their alleged involvement in the fraud. In a significant move on September 1, 2025, the ministry handed over 1,188 case files to the DCI for forensic investigation and potential prosecution. CS Duale has warned that any doctors or facilities found culpable will face severe consequences, including de-registration and legal action.

The investigation has already resulted in several high-profile arrests. In October 2025, Robert Ingasira, a former acting CEO of SHA, was charged alongside three others with defrauding the agency of Sh17.5 million through a clinic in Homa Bay County. In a separate case, directors and clinical officers from Jambo Jipya Medical Clinic in Kilifi County and St. Mark Orthodox Health Centre in Vihiga County were charged with defrauding the SHA of millions of shillings through falsified claims. The Director of Public Prosecutions has approved charges against numerous suspects, ranging from conspiracy to commit a felony to forgery and money laundering.

Impact on Public Trust and Healthcare Access

The scandal has significant implications for ordinary Kenyans, many of whom are now forced to pay out-of-pocket for medical services despite being registered members of the new health scheme. The looting of public funds directly hampers the government's ability to achieve UHC, a cornerstone of its public policy agenda. The situation has eroded public trust in the nascent authority, which was established in October 2024 to replace the scandal-plagued National Health Insurance Fund (NHIF).

Prominent figures have voiced their concerns over the handling of the investigation. Former Chief Justice David Maraga publicly called on the Ethics and Anti-Corruption Commission (EACC) on August 26, 2025, to conduct a swift and thorough probe. He demanded that all stolen funds be recovered and that all individuals involved, including senior officials, be held accountable. Concerns over transparency were further heightened when the public online portal displaying SHA's payments to hospitals, the Kenya Master Health Facility Registry (KMHFR), was temporarily taken down, a move Maraga described as a potential cover-up.

The Path Forward: Sealing Loopholes and Ensuring Accountability

The Ministry of Health maintains that its new digital system is crucial for detecting and flagging fraudulent activities. CS Duale stated that the ministry had intercepted and rejected Ksh 10.6 billion in fraudulent or non-compliant claims. However, the scale of the ongoing fraud suggests significant systemic vulnerabilities remain. As detectives continue to analyze financial records, which show money being rapidly withdrawn from hospital accounts and moved to personal wallets, the focus remains on ensuring a comprehensive and transparent investigation. The successful prosecution of those involved and the implementation of more robust oversight mechanisms will be critical to restoring public confidence and safeguarding the future of healthcare financing in Kenya.