Ministry of Health submits over 1,180 files exposing healthcare fraud to DCI for prosecution
According to the Ministry, the 1,188 files represent the culmination of these enforcement efforts. SHA’s submissions include facilities with proven fraud, others still under investigation, and those closed by KMPDC but previously contracted with SHA.
Over 1,180 files containing evidence of fraudulent activities in Kenya’s healthcare sector have been submitted to the Directorate of Criminal Investigations (DCI) for prosecution, Health Cabinet Secretary Aden Duale has announced.
Speaking on Monday at Afya House in Nairobi, Duale said 1,188 files were handed over, with 190 from the Social Health Authority (SHA) and 998 from the Kenya Medical Practitioners and Dentists Council (KMPDC).
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“SHA and KMPDC have submitted a total of 1,188 files with supporting evidence to the DCI. 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 submission follows recent enforcement measures by SHA, KMPDC, and the Clinical Officers Council against facilities found engaging in malpractice and non-compliance.
Files received
The DCI on Monday confirmed receiving 1,188 files from SHA and KMPDC detailing suspected cases of healthcare fraud.
According to the DCI, a multi-agency team has been formed to review the cases to prosecute all those implicated, “regardless of their social status and political affiliations.”
The agency further stated it will work with other law enforcement bodies to recover assets and resources obtained fraudulently, pledging to provide regular updates on the investigations.
Reaffirming its commitment to the fight against corruption, the DCI urged the public to remain vigilant and report fraud through its #FichuaKwaDCI toll-free number 0800 722 203 or via WhatsApp on 0709 570 000.
85 facilities suspended
SHA has already suspended 85 facilities to allow investigations, citing cases of manipulated billing practices, falsified records, outpatient visits reclassified as inpatient admissions, and claims for services provided to non-existent patients.
At the same time, KMPDC has intensified inspections, shutting down 544 unregistered or unlicensed facilities and revoking licenses for 454 others. Duale said these closures targeted facilities operating below required standards, employing unlicensed practitioners, or lacking essential infrastructure, all of which posed direct risks to patient safety.
According to the Ministry, the 1,188 files represent the culmination of these enforcement efforts. SHA’s submissions include facilities with proven fraud, others still under investigation, and those closed by KMPDC but previously contracted with SHA. The KMPDC files focused on facilities operating in violation of the law, highlighting the wide scope of non-compliance.
“This is part of a multi-agency collaboration. Officers from the DCI, Ministry of Health, SHA, KMPDC, and DHA will investigate and ensure that all perpetrators—be they facilities, doctors, or patients—face the full force of the law,” Duale said.
He outlined the legal consequences for fraud and non-compliance. Under the Social Health Insurance Act, 2023, facilities that knowingly alter information to defraud the Authority face fines of up to Sh2 million, suspension, or removal from the register of empanelled providers.
User rights withdrawn
SHA has already withdrawn user rights for 12 healthcare professionals implicated in criminal schemes and is pursuing recovery of funds obtained through fraudulent claims.
Similarly, the Medical Practitioners and Dentists Council Act imposes fines of up to Sh10 million or imprisonment of up to five years on facilities operating without licenses or employing unregistered practitioners.
Duale also highlighted the use of technology in detecting fraud, saying Kenya now has a comprehensive digital system powered by artificial intelligence and a big data fraud engine.
“Every transaction made by patients, doctors or facilities is recorded in real time. This system gives us the power to detect, analyse patterns, and stop fraudulent transactions,” he said.
He warned that anyone engaging in healthcare fraud is now subject to the criminal justice system and urged Kenyans to play their part.
“Please report any concerns or information regarding fraudulent activities to SHA via the toll-free number 147. Your participation is vital to securing a healthier future for our nation,” Duale said.
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