The Directorate of Criminal Investigations (DCI) has launched a major investigation into widespread healthcare fraud within the Social Health Authority (SHA) after receiving over 1,000 case files from Health Cabinet Secretary Aden Duale.
In a statement issued on Monday, September 1, the DCI confirmed receipt of 1,188 files containing details of individuals, entities, and institutions suspected of engaging in fraudulent activities in the healthcare sector.
To expedite investigations, the DCI has formed a multi-agency task force to review the files and ensure all those implicated are prosecuted, regardless of their social or political standing.
“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 statement read.
“The objective of this review is to ensure that all those involved in any form of healthcare fraud will be arraigned.”
The DCI also confirmed that asset recovery efforts will be part of the operation, targeting resources acquired through fraudulent means. The agency has committed to keeping the public informed on the progress of the investigations.
Three Categories of Fraud Cases
During the handover, CS Duale explained that the cases were grouped into three categories:
- Category 1: 24 health facilities with conclusive evidence of fraud.
- Category 2: 61 facilities with ongoing investigations.
- Category 3: 105 cases closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) but still under SHA contracts.
The KMPDC submitted 988 of the 1,188 files, documenting numerous violations including:
- Billing for procedures not performed.
- Falsifying medical records.
- Upgrading outpatient visits to inpatient claims.
- Charging for services provided to fictitious patients.
Healthcare providers found guilty of fraudulent activities could face stiff penalties under the Social Health Insurance Act, 2023, including:
- Fines up to sh 2 million, suspension, and de-listing from SHA.
- Operating without licences or employing unregistered practitioners could result in fines of up to sh 10 million or up to five years in prison, under the Medical Practitioners and Dentists Council Act, CAP 253.
This development comes just days after the KMPDC announced the closure of 544 health facilities and the revocation of licences for 454 hospitals nationwide. The affected institutions were found to be unlicensed, substandard, or employing unregistered personnel, in violation of SHA and KMPDC regulations.
A gazette notice dated Friday, August 29, formalized the closures, signaling an intensified crackdown on malpractice in Kenya’s healthcare system.
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