NAIVASHA, Kenya — Former Acting Chief Executive Officer of the Social Health Authority (SHA), Robert Ingasira, was arrested on Wednesday in connection with fraudulent medical claims amounting to Sh17.5 million submitted to the State health insurer.
Ingasira was apprehended in Naivasha following investigations into false claims allegedly filed by Archprime Medical Clinic in Homa Bay County.
The clinic is accused of defrauding the authority of Sh17,591,473 through falsified billing and patient data.
The Directorate of Criminal Investigations (DCI) confirmed that Ingasira’s arrest follows a probe approved by the Office of the Director of Public Prosecutions (ODPP), which sanctioned multiple charges against him and eight others.
Among the charges are conspiracy to defraud under Section 317 of the Penal Code, misappropriation of funds under Section 48(2) of the Social Health Insurance (SHI) Act, and abuse of office contrary to Section 101 of the Penal Code.
Also wanted in connection with the fraud is Elijah Wachira, another former SHA chief executive, who remains at large. Authorities believe Wachira and Ingasira may have overseen a network of fraudulent claims linked to multiple health facilities.
In addition to Archprime Medical Clinic, detectives have linked two other medical facilities to similar schemes.
At Vebeneza Enterprise Medical Clinic in Nairobi County, suspects Justus Odhiambo Ouma and Vera Atieno Otieno were arrested for an alleged Sh1,101,760 fraudulent claim.
Three other individuals — Bill Clinton Ochieng, Cynthia Odhiambo, and Phelix Otieno — were arrested at Rachuonyo East Sub-County Hospital over a falsified claim of Sh535,840. Meanwhile, Noah Odhiambo Were was detained for allegedly submitting a Sh315,840 false claim at Nyatoto Health Centre in Homa Bay.
Detectives said the arrests followed a months-long investigation into irregular payouts under the SHA’s outpatient claims system. The probe reportedly uncovered a coordinated effort by clinic administrators and complicit officials to process falsified claims using manipulated patient records.
The ODPP, after reviewing the DCI’s investigation files, approved the suspects’ prosecution, citing sufficient evidence of financial impropriety and abuse of office. “The arrests mark a significant step in the government’s efforts to safeguard public funds within the health insurance sector,” a senior DCI official told The Star on condition of anonymity.
The Social Health Authority, formerly the National Health Insurance Fund (NHIF), has been under scrutiny since transitioning to the new Social Health Insurance (SHI) framework earlier this year. The reforms were designed to eliminate corruption loopholes that plagued the NHIF.
The arrests come amid President William Ruto’s renewed directive to combat graft in the health sector following revelations of inflated medical claims and unverified payments.
The Ministry of Health and investigative agencies have since vowed to intensify audits across hospitals and clinics contracted under the new SHI scheme.
The suspects are expected to be arraigned once investigations are completed. The DCI has urged the public to report any suspicious claims or malpractice involving SHA facilities to aid the ongoing crackdown.
