Health CS Aden Daule has revealed that the Ministry of Health has turned down claims worth Ksh10.6 billion from health providers under the Social Health Insurance Fund (SHIF).

In a press release on the ministry’s X account on Monday, August 25, 2025, the CS cited fraudulent activities and non-compliance with requisite medical regulations as factors that informed the rejections.

“Claims worth Ksh10.6 billion have been rejected due to fraudulent activities or non-compliance. This action is taken under the authority of Section 48(5) of the Social Health Insurance Act, 2023, which outlines penalties for providers who knowingly or fraudulently alter information to defraud the Authority,” part of the CS presser to the media stated.

The CS also confirmed that they are currently re-evaluating claims worth Ksh3 billion due to missing documents and claims worth Ksh2.1 billion being under surveillance for further investigation.

Under the Social Health Agency (SHA) system, Duale confirmed the ministry had received claims to SHA totalling Ksh82.7 billion from health facilities.

Out of the amount, the ministry has since paid Ksh 53 billion for claims submitted by health facilities, with claims totalling Ksh6.4 billion being approved and merely pending payment for the period of July 2025, which will be paid in the next cycle.

 “This rigorous process is a key part of the Authority’s function under Section 35(2) of the Social Health Insurance Act, 2023, which mandates the Claims Office to review, process, and validate medical claims and conduct quality assurance surveillance,” the statement continued.

Additionally, the ministry is currently reviewing claims totalling Ksh7.6 billion for August 2025.

Commitment to openness

While citing the ministry’s anti-fraud stance and commitment to constitutional and fiscal responsibility as articulated in Article 43(1)(a) of the Constitution, which guarantees every Kenyan the right to the highest attainable standard of health, the CS emphasised that this right must be protected by ensuring that every public shilling is directed toward legitimate, life-saving services.

“Every shilling contributed to the Social Health Insurance Fund must go towards legitimate, life-saving healthcare,” the CS said.

The CS also highlighted the ministry’s commitment to continue an over-the-board data policy through publishing the list of all health facilities paid for by the SHA.

 “We continuously publish the list of all health facilities paid by the Social Health Authority (SHA), even though we aren’t legally required to. This public-facing approach ensures the public can hold us and healthcare providers accountable,” the CS explained.