NAIROBI, Kenya – The Ministry of Health has handed over 1,188 case files of suspected healthcare fraud to the Directorate of Criminal Investigations (DCI), in what officials describe as one of the most significant crackdowns in Kenya’s health sector.
Health Cabinet Secretary Aden Duale confirmed the move on Monday, saying the files contain detailed evidence against fraudulent and non-compliant health facilities and individuals.
“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,” Duale said.
The files were submitted following weeks of joint investigations by the Social Health Authority (SHA), the Kenya Medical Practitioners and Dentists Council (KMPDC), and the Clinical Officers Council (COC).
The teams carried out forensic audits and digital system checks that exposed widespread malpractice.
Duale disclosed that SHA has already suspended 85 health facilities linked to fraud pending further investigations.
According to the CS, investigators identified three main fraudulent schemes:
- Upcoding: billing for more expensive procedures than those carried out.
- Falsification of records: submitting false or altered medical documents.
- Outpatient-to-inpatient conversion: illegally billing outpatient visits as hospital admissions.
“These fraudulent practices directly harm the public and drain resources meant for patients. They will not be tolerated,” Duale warned.
He stressed that the crackdown is part of wider reforms aimed at restoring public trust in healthcare institutions and ensuring that funds are used for patients rather than siphoned off by rogue providers.
