The government has suspended 40 health facilities from participating in the national health insurance programme, citing suspected fraudulent activities.
The decision was officially communicated through a Gazette Notice dated August 8, 2025, issued under the Social Health Insurance Act, 2023.
According to the notice signed by Social Health Authority (SHA) CEO Dr. Mercy Mwangangi, the listed facilities have been suspended in line with Section 48(6) of the Act.
“In accordance with the provisions of the Social Health Insurance Act, the health facilities set out in the Schedule shall not be entitled to any benefit from the Social Health Authority during the period of their suspension,” the notice stated.
The affected hospitals are spread across 12 counties: Homa Bay, Nairobi, Bungoma, Kakamega, Vihiga, Busia, Kajiado, Wajir, Kisumu, Kilifi, Mandera and Kirinyaga.
Health Cabinet Secretary Aden Duale confirmed the suspensions during a Friday press briefing, emphasizing that the action takes immediate effect.
“These suspensions take effect immediately. During the investigation period, the facilities will not receive any benefits from SHA, and we will recover all lost funds,” Duale said.
He added that several health professionals, including eight doctors operating in Nairobi, Bungoma, and Kilifi, have also been implicated in the scandal.
“Any doctor or health official involved in defrauding SHA will be held personally responsible,” he warned.
Duale revealed alarming trends in fraud, including the deliberate inflation of outpatient cases to inpatient status—particularly in Nairobi and Homa Bay and incidents of multiple billing and ghost patients.
“In Mandera County, four facilities submitted claims for the same patient who was only admitted to one facility,” he noted.
The Cabinet Secretary further announced that the names of the suspended hospitals would be published in the Gazette and handed over to the Directorate of Criminal Investigations (DCI) for further probe.
“We will hand over the facilities and the 12 implicated health officials to the DCI. Additionally, we’ve directed the relevant regulatory bodies to revoke their licenses,” Duale stated.
The crackdown comes amid ongoing efforts to streamline and safeguard the newly implemented Social Health Insurance scheme, which has faced various hurdles including low uptake in some regions.
Discussion about this post