How MoH has strengthened transparency to curb healthcare fraud, costs - PS Oluga

The Ministry of Health is using unprecedented transparency to fight healthcare fraud, giving the public full access to hospital payment data for the first time.

Principal Secretary in the State Department for Medical Services, Ouma Oluga, during an interview with Radio Generation on Tuesday,  said the initiative aims to strengthen accountability in the health sector.

Hundreds of facilities have been closed or downgraded, while claims are being investigated to ensure services match payments and reduce healthcare costs.

Oluga explained that public concern over healthcare payments is largely due to the government sharing information openly. She noted that for the first time in the history of the National Insurance Fund, the public can view how much hospitals have been paid for services.

“There is no time in the 62 years of NHIF that anyone ever read a claim of how much a hospital has been paid. This is the first time in the history of the world that you can go on our website and see that this hospital was paid this much, and that is part of the transparency and accountability that we want to institute,” Oluga said.

He emphasized that accountability extends to both government authorities and healthcare facilities.

“So the accountability is both on ourselves and the facilities. So we call it social accountability, like the facility must also account. So just like we have to account while the hospital was paid, the facility must also account to the public that, you know, everyone comes from some place,” Oluga explained.

The Principal Secretary also clarified that every claim corresponds to a service received, with investigations focusing on whether services were not offered or were exaggerated.

“Every single claim means that somebody should have gotten a service. So the discussion is, was somebody paid for a service that was not offered or somebody was paid for a service that was exaggerated,” he said.

To address irregularities, the ministry has closed 728 facilities, mostly private, and downgraded 301 government facilities that were being upgraded beyond their actual service level, sometimes due to political influence.

In June 2025, Health Cabinet Secretary Aden Duale announced the closure of 728 ghost or unlicensed facilities.

Duale noted that this has been achieved through digitisation of the health Sector.

He said the closures are part of a crackdown by the ministry, following inspections by the Kenya Medical Practitioners and Dentists Council (KMPDC), Digital Health Agency (DHA), and Social Health Agency (SHA).

The closed facilities were found to be operating without proper licensing, registration, or failing to meet minimum operational and safety standards.

On SHA payments, PS Oluga explained that while the Kenya Medical Practitioners and Dentists Council handles registration, SHA ensures that payments match the services actually provided.

He highlighted that fraud in Kenya’s healthcare sector ranges between 28 and 35 percent of claims, affecting both public and private insurers.

“We have even met with the private medical insurance providers, because they are suffering a bigger problem than SHA. So the fraud generally in Africa Kenya, is anything between 28 and 35% in the medical sector,” Oluga stated, citing examples of inflated charges, such as a Panadol costing 30 shillings but billed at 1,500 shillings in some hospitals.

PS Oluga said the ministry is committed to working with both regulators and healthcare providers to ensure proper verification, identification, and payment of claims.

In addition, he urged the public to recognize the government’s efforts, stressing that the information shared allows all stakeholders to move together toward accountability.

“The public is one month late, you know, but it’s because we have given them the information, but it’s legitimate, and it’s something that we are working very hard with them, and we want this is how we want it to be, that we are all together so that information will be there we will all move together,” the PS conlcuded.