NAIROBI, Kenya – Twelve health officials — including eight doctors — are under investigation for allegedly defrauding the Social Health Authority (SHA), Health Cabinet Secretary Aden Duale has revealed.
The officials, drawn from Nairobi, Bungoma, and Kilifi, are accused of engaging in fraudulent billing and filing false patient claims.
Their cases have been referred to the Directorate of Criminal Investigations (DCI), with regulatory bodies ordered to revoke their licences.
“Any doctor or health official involved in defrauding SHA will be held personally responsible,” Duale told reporters on Friday. “We will hand over all the hospitals and the 12 health officials to the DCI for further investigations.”
The probe is part of a wider crackdown in which the Ministry of Health has suspended 40 hospitals from the SHA programme, effective immediately, pending investigations.
According to Duale, common fraudulent practices included inflating claims by converting outpatient cases into inpatient admissions — particularly in Nairobi and Homa Bay — and billing for “ghost patients.”
“In Mandera County, four different facilities submitted claims for the same patient who was only admitted to one facility,” he said.
The CS said the suspended hospitals will be surcharged for any public funds lost, barred from receiving SHA benefits during the probe, and named in a Gazette Notice once investigations conclude.
Duale warned that both private and public sector culprits will face prosecution, saying the fraud undermines healthcare delivery.
“This behaviour undermines the integrity of our health system and robs deserving Kenyans of essential services. We will not tolerate it,” he said.
