Digitisation of SHA will detect fraud

On 24 August 2025, President William Ruto stated that the digitisation of the Social Health Authority (SHA) system will help the government detect fraud. The promise was part of broader healthcare reforms aimed at making SHA more transparent and accountable through digital technology.

• Officials from the SHA and the Ministry of Health have stated that the digital platform can identify unusual claims, duplicate treatments, or suspicious hospital billing patterns more quickly than the old NHIF system. 
• Despite this, there are concerns that are still raised about the SHA digital sysytem. Some hospitals have complained that the system occasionally flags legitimate claims as suspicious, leading to delayed payments and disruptions in service delivery.
• There have also been concerns about cybersecurity and the protection of patients’ personal data within the digital platform. In addition, investigations and public reports suggest that the system is still facing accuracy challenges during its rollout phase, particularly in areas such as AI-based assessments, claims verification, and the classification of vulnerable households.
• Most importantly, investigations and audits found that SHA has lost billions of shillings through fraudulent claims, including “ghost hospitals” (facilities that exist on paper but not physically), fake patient admissions, double billing for services not provided and Inflated or fabricated treatment claims. An audit reported about KSh 11 billion lost to fraud between Oct 2024 and Apr 2025.
• The same scandal noted that many claims came from private hospitals submitting false or exaggerated bills.
• The government reports that there are nationwide crackdowns ongoing against hospitals and individuals abusing SHA and that there have been ongoing investigations hospital administrators, medical staff and officials linked to SHA systems. There’s further claims that some suspects have been arrested and charged in court over multimillion-shilling fraudulent claims. Moreover, there are reports that some hospitals have reportedly already been flagged or suspended over irregular claims.