The Ministry of Health has entered into an agreement with players in the insurance industry to collaborate in eliminate rising cases of fraud as part of a broad plan to restore public trust in the sector.

Some of the target areas where the ministry will work with insurers are measures to eliminate the billing of ghost patients.

"The meeting agreed on anti-fraud measures including biometric verification, joint audits, and a shared database of fraudulent providers," an update from the Ministry shared on Monday stated.

Additionally, in the meeting with CEOs of medical cover providers, Health Cabinet Secretary Aden Duale explored areas of partnership, particularly with the Social Health Authority (SHA), "aimed at expanding access to quality and affordable healthcare for all Kenyans, regardless of age or economic status."

The parties agreed that insurance firms will henceforth provide plans beyond State-backed Social Health Authority's (SHA) package such as the provision of overseas care, elective procedures, or premium add-ons to patients.

Furthermore, the insurers agreed to enter into co-financing programmes for chronic care cases alongside SHA’s Emergency, Chronic, and Critical Illness Fund (ECCIF).

Going forward, the insurance company chiefs agreed to link their systems to SHA’s centralized claims platform, to enable real-time verification, and faster processing of claims.

This measure is also poised to ensure unscrupulous hospital players do not engage in double billing, in line with the Digital Health Act (2023) and Data Protection Act (2019).

"CEOs requested the Ministry’s support in strengthening the National Health Registry to provide a standardized and accessible platform for healthcare information, and the establishment of a regulatory framework for drug pricing to enhance transparency, accountability, and integrity in the sector," the ministry stated in an update.

Duale called for a Public–Private Collaborative framework between MoH, SHA, the Association of Private Insurers, and IRA — starting with tariff alignment, data sharing, and fraud elimination.

Early this month, the Ministry of Health barred up to 40 health facilities in Kenya from billing the SHA due to persistent cases of fraudulent activities including upcoding, falsifying records, fake inpatient billing, multiple billing, and ghost patients.

Also affected in the measure following a spot audit by SHA were 12 health professionals who caught engaging in fraudulent activities.

“They [40 health facilities] have engaged in corruption and theft of public resources. The suspension is effective immediately,” Duale stated.

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