The Ministry of Health has partnered with medical insurance companies to roll out a Joint Anti-Fraud Action aimed at eliminating ghost patients, penalising malpractice, and restoring public trust in the health sector.
Health Cabinet Secretary Aden Duale on Monday held a meeting with chief executives of medical insurance companies at Afya House, Nairobi, to explore areas of collaboration with the Social Health Authority (SHA).
The talks centred on expanding access to affordable, quality healthcare for all Kenyans, regardless of age or economic status.
The meeting resolved to implement anti-fraud measures including biometric verification of patients, joint audits, and the creation of a shared database to track fraudulent providers.
Duale also briefed insurers on ongoing reforms under the Taifa Care programme, anchored in the Social Health Insurance Act, Primary Health Care Act, Digital Health Act, Facility Improvement Financing Act, and the forthcoming Quality of Care and Patient Safety Bill.
According to the Ministry, the reforms introduce a regulator for service standards, a key step in advancing Universal Health Coverage (UHC).
Both parties further agreed that insurers will complement SHA by offering additional benefits such as elective procedures and overseas treatment, while co-financing chronic care under the Emergency, Chronic and Critical Illness Fund (ECCIF).
Insurers will also link their systems to SHA’s centralised claims platform for real-time verification and faster processing. In addition, both sides will adopt harmonised accreditation standards to guarantee that all Kenyans access care under uniform quality benchmarks.
Insurers, on their part, urged the Ministry to strengthen the National Health Registry to serve as a reliable, accessible source of health data.
They also requested a clear regulatory framework for drug pricing to enhance transparency and accountability across the sector.
Duale acknowledged the structural challenges facing the health system and said the Ministry is addressing them through data-driven reforms and new laws designed to restore public trust.
He proposed a public–private collaborative framework bringing together the Ministry, SHA, the Association of Private Insurers, and the Insurance Regulatory Authority to focus on tariff alignment, data sharing, and fraud prevention.
The meeting brought together senior health officials and industry leaders, including PS for Medical Services Dr. Ouma Oluga, SHA CEO Dr. Mercy Mwangangi, DHA CEO Eng. Anthony Lenayara, KMPDC CEO Dr. David Kariuki, and executives from various insurance companies.
