Fear and uncertainty have gripped Kenya’s healthcare sector after Health Cabinet Secretary Aden Duale submitted 1,188 files of alleged fraudulent hospitals to the Directorate of Criminal Investigations (DCI) for probe.
The files, delivered on Monday, September 1, were compiled by the Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC). SHA submitted 190 files, while KMPDC forwarded 998.
According to Duale, SHA’s cases fall into three categories: 24 health facilities where fraud has been proven, 61 under active investigation, and 105 previously closed cases that still held SHA contracts. The 998 KMPDC files relate to hospitals allegedly operating illegally or violating medical regulations.
The facilities are accused of falsifying medical records, inflating bills, converting outpatient visits into inpatient claims, and invoicing for treatment given to nonexistent patients.
“The SHA and KMPDC have today submitted a total of 1,188 files and supporting evidence to the DCI — a major step in their joint fight against healthcare fraud,” said CS Duale.
“This action targets fraudulent and non-compliant healthcare facilities and individuals, marking a critical milestone in the ongoing effort to protect public funds and safeguard the integrity of Kenya’s healthcare system,” he added.
If convicted, hospital owners found guilty of fraud risk fines of up to KSh2 million, suspension, and removal from SHA’s list of accredited providers under Section 48(5) of the Social Health Insurance Act, 2023.
Individuals running unlicensed health facilities or hiring unregistered practitioners face penalties of up to KSh10 million or five years in prison, as provided under Section 22 (4) and (5) of the Medical Practitioners and Dentists Council Act, CAP 253.
The CS further revealed that a multi-agency team — comprising SHA, KMPDC, DCI, and the Directorate of Health Administration (DHA) — will lead the crackdown against fraud in the health sector.
“Let me be clear: as previously warned, any facility, doctor, or patient involved in fraud is now under the jurisdiction of our criminal justice system and will be prosecuted to the fullest extent of the law,” Duale warned.
The move comes just days after KMPDC announced the closure of 544 health facilities and revoked licences for another 454 across the country for violating SHA regulations.
A gazette notice dated Friday, August 29, indicated that the facilities were either unregistered, operating below required standards, or employing unlicensed medical personnel.
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