Health Cabinet Secretary Aden Duale now says that the Ministry of Health blocked fraudulent health insurance claims amounting to Ksh11 billion through the use of an artificial intelligence-powered verification system.
In an interview on Wednesday, January 28, Duale disclosed that the health payments platform is equipped with an AI fraud detection engine supported by auditors and medical professionals.
"Our system has the latest AI fraud engine. In our own system, we have forensic and risk auditors. We have a team of clinical review doctors. That is why we found out that Ksh11 billion of fraudulent claims have been rejected. If we had to pay, there could have been a loss of public funds," he said.
Duale stated that the rejected claims will not be paid under any circumstances, adding that those behind the attempted fraud will be exposed publicly.
"Respectfully, you cannot call a minister a liar. You can call me a liar, you can call me a bulldozer, you can call me anything, but we will not pay the rejected Ksh11 billion. We are going to publish all these people who wanted to get the Ksh11 billion fraudulent rejected claims," he added.
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Duale further pointed out that the health system processes claims in under a minute and accused some facilities of deliberately delaying services to push patients into paying cash.
He noted that such practices are now being actively monitored.
"Our system turnaround is less than 1 minute. Some facilities want to frustrate patients so that they wait, and then they pay out of pocket. The system is doing vigilance on such facilities," he further said.
This comes days after Duale issued a breakdown of Ksh92.5 billion disbursed to health facilities across the country under the new national health financing framework.
In a statement on Sunday, January 25, he said the payments are part of a structured system designed to ensure accountability, value for money, and uninterrupted service delivery to Kenyans.
Duale revealed that thousands of facilities have already been formally onboarded into the new system and are actively offering services under the framework.
"I wish to clarify concerns that have been raised regarding payments to public, private and faith-based health facilities under the national health financing framework. Clinical review and verification of submitted claims is an ongoing and rigorous process, undertaken to ensure accuracy, value for money and full compliance with established guidelines.
"To date, 10,272 health facilities across the country have been successfully contracted and are actively participating in service delivery under these arrangements," the statement read.
Duale then broke down the actual figures already disbursed across the different financing windows, detailing how the total Ksh92.5 billion has been allocated to support various categories of healthcare services and beneficiaries.
"In terms of disbursements already made, Ksh13 billion under the Primary Health Care (PHC) framework to support frontline and preventive health services; Ksh75 billion through the Social Health Insurance Fund (SHIF) to facilitate access to essential and specialized healthcare services; Ksh3.5 billion under the Public Officers Medical Scheme, ensuring continuity of care for eligible beneficiaries; and Ksh1 billion paid to the Emergency, Chronic and Critical Illness Fund, providing vital support for life-saving interventions," the statement added.
Duale stressed that the government remains committed to running the new financing framework with full transparency and integrity, even as clinical reviews continue and pending claims await settlement.
"Transparency, accountability and prudent stewardship of public resources remain central to this process. We will continue to engage openly with stakeholders, provide timely updates and uphold the highest standards of integrity as clinical reviews progress and outstanding claims are settled in accordance with the law," the statement concluded.
