SHA suspends 45 health facilities amid crackdown on fraudulent claims
The suspended facilities are spread across 17 counties, with Mandera bearing the highest number at nine.
The Social Health Authority (SHA) has suspended 45 health facilities across various counties, declaring they will not be entitled to any benefits under the Social Health Insurance Act, 2023, during the period of suspension.
In a gazette notice dated August 26, 2025, SHA Chief Executive Officer Mercy Mwangangi said the action was taken in exercise of powers under section 48 (6) of the Social Health Insurance 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 said.
The suspended facilities are spread across 17 counties, with Mandera bearing the highest number at nine. Homa Bay follows with five facilities, while Kisii has four. Other affected counties include Kisumu, Kakamega, Garissa, Bungoma, Meru, Kirinyaga, Narok, Turkana, Busia, Nandi, Kajiado, Migori, Uasin Gishu and Nairobi.
Among the facilities named in the gazette notice are Aasif Medical and Health Service Limited in Mandera, Abakore Nursing Home in Wajir, Abala Healthcare in Kisumu, Akemo Valley Maternity and Nursing Home in Narok, and Alasland Hospital in Turkana. Others include Al-Baitul Tiiba Hospital in Garissa, Artan Medical Centre in Wajir, Aspro Medecol Solutions in Kakamega, Ayale Medicare and Nursing Home in Mandera and Chala Health Services in Homa Bay.
The suspension list also features Chemwaa Health Centre in Bungoma, Dawafront Pharmacy and Clinic in Kisumu, Desertview Healthcare Services in Mandera, Equity Afia branches in Homa Bay and Mandera, and Filyne Chima Hospital in Kisii. Garissa Doctors Clinic and Gopima Medical Centre in Kisii were also cited, alongside Grassroot Community Healthcare in Bungoma and Guardian Hospital in Meru.
The suspensions come amid a wider government crackdown on fraudulent billing practices in the health sector.
On Monday, Health Cabinet Secretary Aden Duale revealed that forensic audits had exposed troubling schemes such as unsupported maternity claims, fabricated clinical records, suspicious admissions of hospital staff as patients, and instances where patients were simultaneously listed as being treated in multiple hospitals.
Duale said the ongoing crackdown has also uncovered widespread malpractice, including upcoding, falsifying records, converting outpatient visits into inpatient claims, and billing for non-existent patients.
He explained that these latest suspensions add to 40 facilities recently sanctioned by SHA, alongside 728 already closed and 301 downgraded by the Kenya Medical Practitioners and Dentists Council.
He stressed that the ministry had adopted a zero-tolerance approach since he assumed office in April, supported by a new digital system designed to detect and eliminate loopholes that plagued the now-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.”
According to Duale, claims worth Sh5.1 billion submitted to SHA are currently under re-evaluation and surveillance as the government steps up its crackdown on fraudulent billing. He disclosed that since the rollout of TaifaCare last October, SHA had received claims amounting to Sh91.7 billion from hospitals under the Primary Health Care (PHC) and Social Health Insurance Fund (SHIF) schemes.
Out of this, Sh60.7 billion has been disbursed, with Sh6.4 billion already approved and awaiting release.
However, not all claims passed scrutiny.
“Claims worth Sh3 billion are being re-evaluated due to missing documents, while an additional Sh2.1 billion is under surveillance for further investigation,” Duale said.
He added that his ministry had outrightly rejected claims worth Sh10.6 billion, citing fraudulent practices such as upcoding, falsification of medical records, conversion of outpatient cases into inpatient admissions, and phantom billing.
He pointed to recent audits that exposed malpractice in specific hospitals. Duale said, “These actions contravene Section 48(5) of the Social Health Insurance Act, 2023, which prescribes penalties for providers who knowingly alter or falsify information to defraud the Authority.”
SHA data further shows that out of Sh9 billion in PHC claims submitted, Sh7.7 billion has already been paid. Similarly, hospitals have submitted Sh82.7 billion under SHIF, of which Sh53 billion has been released. Some Sh7.6 billion in claims for August remain under review.
The suspensions, according to the gazette notice, took effect on August 26, 2025, and will remain in force for the period stipulated by the law.
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