Five suspects to be arraigned over SHA hospital claims fraud
The files, handed over by SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC) on September 1, followed public complaints about suspected ongoing fraud in the health sector. They cover individuals and organisations accused of undermining government efforts to deliver quality healthcare.
Five Kenyans will face court on Monday, October 6, 2025, over alleged fraudulent hospital claims at the Social Health Authority (SHA).
The Directorate of Criminal Investigations (DCI) announced the development on Friday, noting that the suspects were identified after an extensive review of files submitted by Health CS Aden Duale.
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"We wish to inform the general public that the 1,188 files are at various stages of investigation. Currently, five suspects are in custody pending arraignment on Monday, October 6, 2025. Efforts to apprehend additional suspects are already underway, following approval from the ODPP," the DCI stated.
The files, handed over by SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC) on September 1, followed public complaints about suspected ongoing fraud in the health sector. They cover individuals and organisations accused of undermining government efforts to deliver quality healthcare.
"Thorough and expedient investigations were immediately initiated upon receipt of the files. A multi-agency team, led by the DCI, was formed to conduct a comprehensive review of the materials. The aim is to ensure that all individuals involved in any form of healthcare fraud are held accountable for their actions," the DCI said.
Those in custody will face 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.
Duale categorised the SHA files into three groups: Category 1 included 24 facilities with confirmed fraud; Category 2 involved 61 facilities under investigation; and Category 3 comprised 105 cases previously closed by KMPDC but still holding contracts with SHA.
Meanwhile, the 998 files from KMPDC covered facilities operating outside legal requirements.
The facilities under review allegedly engaged in various fraudulent practices, including billing for more expensive procedures than performed, falsifying patient records, converting outpatient visits into inpatient claims, and submitting claims for non-existent patients.
Following the receipt of the files, the DCI set up a multi-agency team tasked with tracing assets and resources acquired through fraudulent activities, ensuring that all those responsible face legal consequences.
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