The Directorate of Criminal Investigations (DCI) has launched a multi-agency team to probe widespread fraud at the Social Health Authority (SHA) after receiving more than 1,000 case files.
In a statement on Monday, September 1, DCI confirmed it had received 1,188 files from Health Cabinet Secretary Aden Duale and the Kenya Medical Practitioners and Dentists Council (KMPDC). The files detail individuals, entities, and health facilities suspected of defrauding SHA through false claims and illegal practices.
“Upon receipt of the files, a multi-agency team has been constituted under the leadership of the DCI with a view to expeditiously reviewing the files. The objective of this review is to make sure that all those who have been involved in any form of healthcare fraud will be arraigned regardless of their social status and political affiliations,” the agency said.
The DCI also announced that it would pursue recovery of assets and resources obtained through fraud, while promising to provide Kenyans with regular updates on the investigations.
Duale hands over files
On Monday, CS Duale handed the files to DCI, categorizing them into three groups.
Category 1: 24 health facilities with confirmed fraud.
Category 2: 61 facilities with ongoing fraud cases.
Category 3: 105 cases initially closed by KMPDC but still contracted under SHA.
KMPDC contributed 988 out of the 1,188 files, highlighting facilities that violated licensing requirements and engaged in malpractice.
According to the ministry, fraudulent practices included inflating medical bills, falsifying records, converting outpatient visits into inpatient cases, and filing claims for services given to non-existent patients.
Penalties outlined
Under the Social Health Insurance Act, 2023, healthcare providers found guilty of fraud face fines of up to Ksh2 million, suspension, and removal from SHA’s list of empaneled providers.
Individuals running unlicensed facilities or hiring unregistered medical staff risk fines of up to Ksh10 million or a prison sentence of up to five years under the Medical Practitioners and Dentists Council Act, CAP 253.
The latest move comes days after KMPDC ordered the closure of 544 health facilities and revoked licences of 454 hospitals across the country for violating SHA regulations.
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