The Directorate of Criminal Investigations (DCI) has confirmed significant progress in its ongoing probe into fraudulent claims and irregularities tied to the Social Health Authority (SHA), with five suspects now in custody and set to be arraigned on Monday, October 6.
In a statement released on Friday, the agency said a total of 1,188 files submitted by SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC) are under forensic review.
“Currently, five suspects are in custody pending arraignment. Efforts to apprehend additional suspects are already underway following approval from the ODPP,” the DCI noted.
The suspects are expected to face a raft of charges under the Penal Code, the Proceeds of Crime and Anti-Money Laundering Act, the Social Health Insurance Act, and the Anti-Corruption and Economic Crimes Act.
The agency pledged to ensure accountability and recovery of assets obtained fraudulently. “The DCI remains resolute in its commitment to stopping healthcare fraud, holding all offenders accountable, and ensuring that all assets and resources acquired fraudulently are recovered,” it added.
The files handed over on September 1 included 190 from SHA and 998 from KMPDC. SHA identified 24 facilities where fraud evidence was conclusive, 61 still under probe, and 105 already closed but still contracting with the Authority. KMPDC’s files implicated facilities accused of operating illegally.
According to investigators, common fraud tactics included inflating bills by converting outpatient visits into inpatient admissions, falsifying records, billing for procedures never carried out, and submitting claims for non-existent patients.
Health Cabinet Secretary Aden Duale hailed the exercise as a critical milestone in safeguarding Kenya’s healthcare system.
“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 said.
SHA has suspended 85 health facilities for fraudulent activities, revoked user rights for 12 implicated practitioners, and begun surcharging facilities to recover stolen funds.
Meanwhile, KMPDC reported that 544 health facilities were closed for being unregistered or unlicensed, while licenses for 454 others were revoked due to violations ranging from substandard operations to employing unlicensed practitioners.
Civil society actors welcomed the DCI’s actions but called for transparency and non-selective prosecutions.
“Healthcare fraud robs patients of their right to treatment and endangers lives. The government must ensure every shilling lost is recovered and perpetrators, however powerful, are brought to justice,” said Dr. Okiya Omtatah, a governance activist.
As investigations deepen, the scandal underscores the urgency of reforming Kenya’s healthcare oversight systems, ensuring digital tracking of claims, and enforcing strict compliance.
For Kenyans, the outcome of the probe will be a litmus test of whether the state can rein in the entrenched cartels draining the public health sector.
