Fraudulent hospitals back online: RUPHA exposes shocking SHA system failure
Recently, the SHA suspended 45 health facilities across multiple counties, declaring that they would not be entitled to any benefits under the Social Health Insurance Act, 2023, during the suspension period.
The Rural and Urban Private Hospitals Association of Kenya (RUPHA) has alleged that a system bug in the Social Health Authority (SHA) platform caused the reinstatement of healthcare facilities that had been suspended from accessing the portal over fraud investigations or compliance issues.
Recently, the SHA suspended 45 health facilities across multiple counties, declaring that they would not be entitled to any benefits under the Social Health Insurance Act, 2023, during the suspension period. In a gazette notice dated August 26, 2025, SHA Chief Executive Officer Mercy Mwangangi said the move was taken under section 48 (6) of the Act.
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“In exercise of the powers conferred by section 48 (6) of the Social Health Insurance Act, 2023, the Social Health Authority hereby gives notice to the public of the suspension of the health facilities set out in the schedule below. 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,” Mwangangi stated.
System bug
In a statement on X, RUPHA said: “Over the last 24 hours, all facilities that had been suspended from accessing the SHA portal due to either fraud investigations or compliance concerns have had their access to the portal reinstated due to a system bug affecting the SHA system.”
The suspended facilities are spread across 17 counties. Mandera has the highest number at nine, followed by Homa Bay with five and Kisii with four. Other affected counties include Kisumu, Kakamega, Garissa, Bungoma, Meru, Kirinyaga, Narok, Turkana, Busia, Nandi, Kajiado, Migori, Uasin Gishu, and Nairobi.
Health Cabinet Secretary Aden Duale revealed that forensic audits had uncovered several irregularities in some facilities. These included unsupported maternity claims, fabricated clinical records, suspicious admissions of hospital staff as patients, and cases where patients were simultaneously recorded as being treated in multiple hospitals.
Widespread malpractice
Duale added that the crackdown also exposed widespread malpractice, such as upcoding, falsifying records, converting outpatient visits into inpatient claims, and billing for non-existent patients.
He noted that these latest suspensions add to 40 facilities recently sanctioned by SHA, in addition to 728 already closed and 301 downgraded by the Kenya Medical Practitioners and Dentists Council.
Since taking office in April, Duale said he has adopted a zero-tolerance approach to fraud, supported by a new digital system designed to close loopholes that once plagued the defunct National Health Insurance Fund (NHIF).
“The primary function of our digital system is to detect fraud. We have seen that facilities are looking for innovative ways to cheat the system, but our digital architecture is designed to detect and flag anomalies at every stage of the claims process,” he said. “Hence, you will find that fraud can be detected and stopped at any point, including at the payment stage.”
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