According to authorities, more than Ksh.11 billion (about Rwf 124 billion) was siphoned off through fictitious surgeries and fraudulent claims by health facilities within just six months, between October 2024 and April 2025.
Introduced to replace the former National Hospital Insurance Fund (NHIF), the system was designed to modernise access to healthcare and provide improved health coverage for all Kenyans. However, only months after its launch, it is now facing a serious crisis of confidence, with hundreds of facilities accused of manipulating reimbursement claims.
Investigations have uncovered practices such as fictitious treatments, inflated billing, and the registration of 'ghost patients.' Health Cabinet Secretary Aden Duale, appearing before members of the National Assembly in Naivasha this week, revealed a disturbing trend in which expectant mothers were allegedly forced to undergo unnecessary caesarean sections to inflate insurance claims.
'Somebody wants to force a mother to a C-section when she can deliver normally just because they want to get a difference of Ksh.20,000 (Rwf 225,000),' Duale told lawmakers.
National Assembly Speaker Moses Wetang'ula expressed concern over the growing reliance on surgical deliveries.
'We used to see doctors tell mothers to push during birth. Nowadays it is just go to theatre. We want to go back to pushing,' he said.
Authorities said irregularities were detected using artificial intelligence, including one striking case in Kwale County, where an insured individual was listed as having 381 dependents.
'We are handing over that patient to the Directorate of Criminal Investigations (DCI),' Duale said.
In response to the revelations, more than 1,100 health facilities have been closed or suspended, and dozens of medical professionals have been deregistered from the SHA system. Criminal investigations are ongoing, with the Directorate of Criminal Investigations pursuing those implicated in the fraud.
Despite the crisis, the government maintains that the Taifa Care programme, central to Kenya's push for universal health coverage, will continue. Officials say tighter controls and stronger oversight measures are being implemented to restore public trust and ensure the system operates fairly for all Kenyans.
Wycliffe Nyamasege
