NAIROBI, Kenya — Eight individuals and a private clinic stand accused of defrauding Kenya’s Social Health Authority (SHA) of over Ksh 7 million through allegedly falsified medical records and forged claims, according to charges filed this week by the Office of the Director of Public Prosecutions (ODPP).
The case involves two separate schemes. In Kilifi County, staff and directors at Jambo Jipya Medical Clinic are alleged to have submitted fabricated medical information to the SHA between November 1, 2024, and June 30, 2025, resulting in irregular payments of approximately Ksh 2,032,680.
Meanwhile, in Vihiga County, an employee of St. Mark Orthodox Health Centre Limited is charged with conspiring to defraud the SHA of Ksh 5,128,400 during a similar timeframe.
The defendants include Markdhillion Mutsotso, an employee at St. Mark Orthodox Health Centre, Vihiga; Sammy Otieno; Patrick Kanya and Faith Chepkurui, directors at Jambo Jipya Medical Clinic; Steven Okinyi and Justine Baraka, clinical officers; Pauline Wanjiru, a nurse; Naida Mbeyu, a receptionist at Jambo Jipya; And Jambo Jipya Medical Clinic itself.
Each of the accused persons pleaded not guilty to charges including conspiracy to commit a felony, fraudulent alteration and falsification of information, forgery and uttering false documents, cheating, use of proceeds of crime, and falsification of health records.
When they appeared before Chief Magistrate Lucas Onyina, the court released them on a bond of Ksh 600,000 each, pending further proceedings.
The case has been scheduled for mention on October 21, 2025, for further direction.
The allegations emerged from audits triggered by complaints of fraudulent practices in the health sector.
As part of the investigation, the Directorate of Criminal Investigations (DCI) received 1,188 files from SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC). These files identify dozens of facilities under scrutiny for suspected fraud or non-compliance.
Health Cabinet Secretary Aden Duale has been vocal about Kenya’s mounting concerns over healthcare fraud, noting practices that siphon resources intended for public service delivery.
He estimates that in Kenya, as in many other countries, a substantial percentage of medical payouts are associated with bogus claims.
The crackdown has already led to suspension and deregistration of several medical facilities deemed non-compliant in audits.
