For years, the public healthcare system has been bleeding billions through fraudulent claims. 

Hospitals and even some practitioners have been accused of minting illegal cash by making double claims for refunds to the defunct National Health Insurance Fund. 

Some health facilities would bill the fund multiple times for the same patient visit, file for services never rendered, or charge for drugs that were never dispensed. 

According to the government, the racket resulted in massive losses of money that could otherwise strengthen the country’s universal health coverage ambitions. 

To counter the fraud, the government is fighting back in a technological move that it says will avert further losses and enhance service delivery under the Social Health Authority (SHA). 

The government has since launched a biometric system that is expected to seal loopholes that allowed ghost patients, fake prescriptions, and double claims to flourish, a move that could finally put an end to one of Kenya’s most costly healthcare scandals. 

On August 4, 2025, Health Cabinet Secretary Aden Duale unveiled a new verification system that he insisted would bring an end to fraudulent billing and facilitate accountability. 

Speaking during the launch at Kenyatta University Teaching, Referral and Research Hospital (KUTRRH), Duale said the digital system will replace the need for patients to present physical documents to prove SHA compliance. 

“This innovation will secure access to health services without having physical documents. It will help us eliminate fraud and misuse of benefits, reduce paperwork, shorten queues, and allow health workers to spend more time on patient care,” he said. 

Beyond billing 

So far, over 25 million Kenyans have been registered with SHA, with more than 10,000 facilities contracted. 

Since its inception, SHA has reimbursed hospitals to the tune of Ksh47.5 billion, while level two and three facilities have received Sh6.9 billion under the free Primary Healthcare Fund.

To fully heal the system that had started to rot, the government has gone beyond billing, extending its crackdown to pharmaceutical companies. 

CS Duale ordered all pharmaceutical firms to upload certified product data within 30 days or face deregistration, saying the move is part of an effort to rid the market of counterfeit and substandard drugs. 

“Failure to comply will result in deregistration and delisting from SHA. Effective immediately, SHA will only reimburse for drugs dispensed to patients by health facilities,” warned the CS. 

Duale said any facility caught double-billing will be suspended immediately, assuring that every patient interaction from diagnosis to prescription will now be tracked in real time. 

“These reforms will stop theft, manipulation, and ghost billing in public hospitals.”