The Social Health Authority (SHA) has issued a nationwide alert, urging Kenyans to exercise extreme vigilance over their hospital bills and visit records to curb rampant fraudulent activities by some contracted healthcare facilities. This directive, released on Wednesday, October 8, 2025, by SHA Chief Executive Officer Mercy Mwangangi, underscores a critical effort to safeguard the integrity of the newly implemented social health scheme.

Patients are now required to ensure that every hospital visit is accurately captured within the SHA system on the precise date of service. Following a successful log-in, patients will receive a confirmation message on their registered mobile numbers, detailing the visit. This measure is crucial for preventing fraudulent billing, double entries, or incorrect charges that could undermine the sustainability of the national health scheme.

Context of Rising Fraud Allegations

This alert comes amidst growing concerns and ongoing investigations into widespread fraud within the healthcare sector, particularly targeting the Social Health Authority. In October 2024, the SHA replaced the National Hospital Insurance Fund (NHIF) with the aim of providing accessible, affordable, and quality health insurance for all Kenyans.

However, the transition has been marred by allegations of corruption. The Financial Reporting Centre (FRC) uncovered questionable payments totalling Sh558.6 million to 45 hospitals suspected of siphoning public funds through 'ghost claims' between October 2024 and July 2025. These facilities, often with dormant bank accounts, reportedly received millions from the Social Health Insurance Fund (SHIF) and Primary Health Care Fund, with funds subsequently vanishing through suspicious cash withdrawals and mobile money transfers.

In June 2025, an internal report obtained by Citizen TV revealed a well-coordinated fraud network, with dozens of Level 4 and Level 5 hospitals allegedly converting outpatient visits into inpatient claims, admitting patients unnecessarily, and even billing for 'ghost patients.' These facilities reportedly defrauded the government of nearly Sh100 million.

Legal and Governance Framework

The Social Health Insurance Act, enacted on November 22, 2023, established the SHA to manage three distinct schemes: the Primary Healthcare Fund, the Social Health Insurance Fund, and the Emergency, Chronic and Critical Illness Fund. The Act aims to streamline public health insurance and ensure universal health coverage.

Health Cabinet Secretary Aden Duale has consistently warned that healthcare providers found complicit in fraudulent activities will be held personally liable, with facilities surcharged to recover illicitly obtained funds. The Office of the Director of Public Prosecutions (ODPP) has already approved charges against multiple health facilities and their directors, with five suspects arrested in connection with alleged SHA fraud involving 1,188 files.

Stakeholder Engagement and Testimonies

The SHA has contracted 1,442 health facilities, including all public hospitals from Level 2 to 6, to provide services under the new scheme. Private and faith-based hospitals have also largely signed contracts after initial concerns regarding slow reimbursements under SHIF and outstanding debts from the defunct NHIF.

Dr. Mercy Mwangangi, SHA CEO, has reassured Kenyans that the Authority possesses sufficient resources to manage claims, stating in September 2025 that Sh82 billion in claims had been submitted, with Sh53 billion paid out and Sh10.6 billion rejected due to fraud or non-compliance. She emphasized the Authority's rigorous claims review process to safeguard funds.

Evidence and Data

The SHA has implemented a biometric identification system for verification across all Level 4, 5, and 6 health facilities, replacing the previous One-Time Password (OTP) system. This is intended to combat fraud, reduce paperwork, and improve efficiency. As of August 2025, over 25.1 million Kenyans had registered with SHA, and more than 10,000 health facilities had been contracted.

In September 2025, the SHA flagged over Sh3 billion worth of claims for missing documentation, giving providers a 14-day window to resubmit the necessary papers via a newly activated 'Missing Documents Resubmission Module' to avoid rejection.

Risks and Implications

The ongoing fraud allegations pose a significant threat to public confidence in President William Ruto's Universal Health Coverage (UHC) agenda. Such schemes could undermine the financial stability of the SHA and compromise its ability to provide affordable healthcare to all Kenyans. The Ministry of Health has warned that any facility, doctor, or patient involved in fraudulent activities will face legal action.

Uncertainties and Controversies

Despite the SHA's assurances of financial stability, concerns persist regarding the system's robustness against fraud and the timely settlement of legitimate claims. Some health workers argue that systemic weaknesses create loopholes exploited by fraudsters. The transition from NHIF to SHA has also faced challenges, including initial confusion and delays in service access for some Kenyans.

Timeline and Next Steps

• October 1, 2024: Social Health Authority (SHA) officially began operations, replacing NHIF.
• October 6, 2024: SHA announced 12,704,548 Kenyans registered and 1,442 health facilities contracted.
• August 4, 2025: Biometric identification system launched for SHA verification in Level 4, 5, and 6 facilities.
• September 15, 2025: SHA flagged Sh3 billion in claims for missing documents, setting a September 30 deadline for resubmission.
• October 8, 2025: SHA CEO Mercy Mwangangi urged Kenyans to verify hospital bills and visit details.

What to Watch

Kenyans should closely monitor their SHA accounts and confirmation messages after hospital visits. The effectiveness of the new biometric verification system and the ongoing investigations into fraudulent claims will be key indicators of the SHA's success in achieving its mandate of universal health coverage.