Nairobi — Medical Services Principal Secretary Ouma Oluga has admitted that the new social health insurance scheme (SHA) is facing massive fraud barely a year after it began paying hospital claims.
Oluga said little-known hospitals some linked to influential figures have received millions of shillings for questionable services, sparking public outrage.
"There are legitimate concerns because of transparency.For the first time in our history, you can go online and see how much each hospital has been paid. But the outrage should also be credited to us for giving out that information,"Oluga said.
A recent media exposé revealed that facilities with limited capacity were paid millions, a development that has raised questions about loopholes in the new system.
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Ministry figures suggest that 28 to 35 percent of medical claims in the country are fraudulent, ranging from inflated bills to ghost services.
The ministry has shut down 728 health facilities and downgraded 301 others in a sweeping crackdown.
"Some facilities claimed to be Level 4 hospitals when they were not," Dr. Oluga said.
"They would present high-end equipment and specialists during inspection, then remove them once licensed. That is why we acted."
He said rogue facilities are suspended immediately once irregularities are confirmed, with files forwarded to the Directorate of Criminal Investigations (DCI) for prosecution.
Despite the scandal, the PS defended Social Health Authority as a step forward in openness.
"For 62 years under NHIF, no one ever saw a hospital's claim payments," he said.
"This is the first time in the world you can go online and see those figures."
PS Oluga highlighted that the ministry's hotline, which receives about 3,000 calls a day, has become a key tool in flagging fraudulent claims and poor service.
The Medical Service PS warned that fraud is not only institutional but also reflects a wider societal problem.
"It is criminal, yes, but it is also cultural.Hospitals register with equipment and top doctors to get licensed, then move them elsewhere. Patients are charged KSh1,500 for Panadol that should cost KSh30. This is everyday fraud," he said.
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He said reforms are being tightened to lower costs and enforce accountability but cautioned that true change requires a shift in values.
"As we point fingers at government, we must also point fingers at ourselves," he said.
"We need people who love this country enough to stop cheating it."
