Health Cabinet Secretary Aden Duale has dismissed claims that the Social Health Authority (SHA) has accumulated more debt in 10 months than the National Health Insurance Fund (NHIF) did in six years.
In a statement on Monday, September 15, the CS dismissed the allegations as misleading and self-serving.
Duale said that while SHA remains firm in its mission to reform Kenya’s health insurance sector, it will not support facilities involved in fraudulent claims.
"SHA is committed to working with genuine health facilities that treat authentic patients, provide proper medication, and submit verifiable claims. However, SHA cannot and will not support facilities involved in fraudulent claims or the misuse of public funds," he said.
Duale remarks came after Kenya Medical Association (KMA) President Simon Kigondu accused the SHA of mismanagement and creating a financial crisis.
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"SHA is not working for health providers; it is fraudulent. The SHA 360 application is ridiculous and limits access to services. SHA has accumulated more debt in 10 months than NHIF did in 6 years," he said in an interview on Monday morning.
Duale, however, criticized Kigondu’s stance, linking him to facilities that had been flagged by the system.
"It is concerning that the Chairman of the Kenya Medical Association appears to be defending some facilities whose fraudulent claims have been rejected or whose operations have been suspended due to serious irregularities.
"However this is not a shock as he owns some of them that are either suspended or flagged by our Digital system," he added.
Duale further defended SHA’s digital verification tool, Practise360, which he said has already disrupted fraudulent practices in the health sector.
"The Practise360 app has already helped stop several fraudulent health workers from colluding with fake facilities to issue pre-authorizations aimed at defrauding SHA.
"Previously, some fraudulent health workers were selling OTP codes to enable false claims, a malpractice that Practise360 has successfully curbed," he further said.
Duale urged the KMA leadership to put patients’ interests first instead of protecting facilities flagged for malpractice.
"We urge the doctor to rise above personal interests and support the ongoing revolution in healthcare being driven by the many honest healthcare workers he represents at KMA," he concluded.
Elsewhere, SHA announced that it has flagged more than Ksh3 billion worth of claims for missing documentation.
In a statement on Monday, September 15, SHA CEO Mercy Mwangangi said the authority has given providers until the end of September to resubmit the required papers or risk rejection.
"As part of the routine claims adjudication exercise, SHA has flagged over Ksh3 billion worth of claims that require more documentation to assist the review teams to adjudicate the claim.
"These documents are in addition to the 3 mandatory documents which are the dully filled claim form, itemized invoice and discharge summary/case summary," the statement read.
According to Mwangangi, the flagged claims will now be processed under a newly activated resubmission module.
"This is therefore to notify you that for claims marked 'missing documents' the Missing Documents Resubmission Module will now be enabled in the system from 16th September 2025," the statement added.
According to SHA, the resubmission process will operate under strict conditions to ensure accountability and transparency.
Key features of the system include a 14-day countdown window, meaning providers have limited time to comply; integrity of submissions, since providers cannot replace or delete original documents; and patient notifications, where patients will receive alerts once a claim is resubmitted.
"Providers are encouraged to act promptly to avoid expiry of the resubmission window before 30th September 2025. On expiry of the same period these claims will transition to rejected," the statement further read.
To ensure compliance, Mwangangi further announced that the authority will carry out monitoring visits.
"Further, SHA will conduct routine surveillance to support compliance. County teams will begin facility visits on 16th September 2025, and providers are urged to cooperate," the statement concluded.
