NAIROBI, Kenya — Five directors of two healthcare facilities have been arraigned in court over their alleged involvement in a fraud scheme targeting the Social Health Authority (SHA), following investigations into suspected irregularities in medical claims.
The accused are directors of Nissi Medical Centre and Dawa Front Healthcare Services, which investigators allege fraudulently claimed millions of shillings from the national health insurer.
According to the Directorate of Criminal Investigations (DCI), the charges followed investigations launched after the Social Health Authority lodged a formal complaint over suspected fraudulent claims submitted by several contracted healthcare providers.
A forensic audit conducted by the Authority reportedly uncovered widespread anomalies in claims processing, including healthcare facilities that had been closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) for non-compliance but allegedly continued operating under active SHA contracts.
Fictitious Claims Alleged
Investigators allege the suspects orchestrated fraudulent schemes involving fictitious medical claims, including claims for patients who were never admitted, falsified medical records and false statements made to obtain payments from the Authority.
The DCI further stated that some claims were submitted by facilities allegedly operating outside the provisions of the Social Health Insurance Act and other applicable regulatory requirements.
According to investigators, Nissi Medical Centre is alleged to have received more than Sh38.7 million through fraudulent claims, while Dawa Front Healthcare Services allegedly obtained more than Sh2.5 million.
Detectives also intercepted additional claims valued at more than Sh8.1 million before they could be processed for payment.
Directors Face Multiple Charges
The accused persons are:
- Dominic Atieno
- Peter Atieno
- Eugine Ochieng
- Enos Osire
- Elija Otieno
They face charges including:
- Conspiracy to commit a felony;
- Making false statements to obtain benefits under the Social Health Insurance Act; and
- Acquisition and use of proceeds of crime contrary to the Proceeds of Crime and Anti-Money Laundering Act (POCAMLA).
The prosecution alleges the offences formed part of a coordinated scheme to unlawfully obtain payments from the Social Health Authority.
Investigations Continue
The Directorate of Criminal Investigations said efforts are ongoing to trace and arrest additional suspects believed to be connected to the alleged fraud network.
Investigators indicated that inquiries into the matter remain active as authorities seek to establish the full extent of the suspected scheme and identify any other individuals involved.
The accused are expected to continue with the court process, where they will have an opportunity to respond to the charges against them.
