Kenya launches Anti-Fraud Initiative with insurers to fix healthcare system

KENYA—The Ministry of Health in Kenya is actively collaborating with key partners to address financial challenges in the healthcare sector.

As part of this effort, the Ministry is launching a Joint Anti-Fraud Initiative aimed at eliminating ghost patients, penalizing malpractice, and rebuilding public confidence in the health system.

Recently, the Health Cabinet Secretary held a meeting at Afya House in Nairobi with Chief Executive Officers from various medical insurance companies.

The purpose was to explore potential partnerships, especially with the Social Health Authority (SHA), to improve access to quality and affordable healthcare services for all Kenyans, regardless of their age or economic background.

During the meeting, the group agreed on several anti-fraud measures designed to ensure transparency and efficiency.

These include the introduction of biometric verification, conducting joint audits, and creating a shared database to identify and monitor fraudulent healthcare providers.

This coordinated approach is expected to reduce financial leakages and abuse within the system significantly.

The Cabinet Secretary also updated the CEOs on ongoing healthcare reforms under the Taifa Care initiative.

These reforms are based on key legislative acts, such as the Social Health Insurance Act, Primary Health Care Act, Digital Health Act, Facility Improvement Financing Act, and the soon-to-be-enacted Quality of Care and Patient Safety Bill.

Together, these laws establish a regulatory framework to uphold service standards, all of which are crucial steps towards achieving Kenya’s goal of Universal Health Coverage (UHC).

Further enhancing this partnership, the meeting reached consensus on introducing Complementary Coverage options.

In this arrangement, insurers will provide additional plans beyond SHA’s basic package, covering services like overseas medical care, elective procedures, and premium add-ons.

Additionally, private insurers will work alongside SHA to co-finance chronic care through the Emergency, Chronic, and Critical Illness Fund (ECCIF).

The discussion also covered Shared Claims and Data integration, with plans to link private insurers to SHA’s centralized claims platform.

This connection will enable real-time verification, accelerate claims processing, and help prevent double billing, in compliance with regulations outlined in the Digital Health Act (2023) and the Data Protection Act (2019).

To ensure quality across the board, the Ministry committed to harmonizing accreditation standards for all healthcare providers.

This move will guarantee that both SHA-insured patients and those covered by private insurance receive consistent and high-quality care.

During the meeting, the CEOs requested Ministry support in strengthening the National Health Registry.

They emphasized the need for a standardized and accessible platform to manage healthcare information effectively.

Additionally, they called for establishing a regulatory framework for drug pricing to enhance transparency, accountability, and integrity within the pharmaceutical sector.

In his remarks, Honorable Aden Duale, the Health Cabinet Secretary, recognized the systemic challenges facing Kenya’s healthcare system.

He reassured stakeholders that the Ministry is tackling these problems through legislative reforms and data-driven initiatives aimed at restoring public trust.

Duale underscored the importance of a collaborative framework involving the Ministry of Health, SHA, the Association of Private Insurers, and the Insurance Regulatory Authority (IRA).

This partnership will focus on aligning tariffs, sharing data, and eliminating fraud.

The Cabinet Secretary was joined by senior officials, including Dr. Ouma Oluga, the Principal Secretary for Medical Services; Dr. Mercy Mwangangi, CEO of SHA; Eng. Anthony Lenayara, CEO of the Digital Health Authority; and Dr. David Kariuki, CEO of the Kenya Medical Practitioners and Dentists Council.

Industry leaders such as Njeri Njomo (CEO, Jubilee Health Insurance), Justine Kosgey (CEO, AAR Insurance), and Japeth Ogalloh (CEO, Old Mutual) also participated in the discussions, reflecting a broad commitment across both public and private sectors to improve Kenya’s health system.

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