DCI forwards 18 SHA fraud cases to ODPP with 24 suspects charged

Social Health Authority (SHA) headquarters in Nairobi. (Photo: SHA)

By Lucy Mumbi
Wednesday, December 17, 2025

The DCI said nine cases have already been approved for prosecution, while the rest await further guidance from the ODPP.

The Directorate of Criminal Investigations (DCI) has forwarded 18 cases involving suspected Social Health Authority (SHA) fraud to the Office of the Director of Public Prosecutions (ODPP), even as detectives continue investigations across multiple counties, aiming to hold culprits accountable.

In a statement on Wednesday, the DCI said nine cases have already been approved for prosecution, while the rest await further guidance from the ODPP.

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“The ODPP approved the prosecution of nine cases, while five more case files are waiting for review and advice from the ODPP. Additionally, three case files have been returned to the DCI for further investigations, and seven case files are still being investigated before being submitted to the ODPP for review and guidance,” the DCI said.

Investigations are ongoing in several counties, including Nairobi, Homa Bay, Wajir, Kilifi, Kakamega, Bungoma, Busia, Kisumu, Vihiga, and Kajiado, with a total of 24 suspects already charged.

The cases were submitted following widespread complaints from Kenyans over irregularities in the health sector. On September 1, 2025, the DCI received 1,188 files from SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC), detailing suspected fraud by individuals and organisations accused of undermining government initiatives to provide quality healthcare.

According to Health Cabinet Secretary Aden Duale, the SHA files were divided into three categories. Category one included 24 facilities where SHA had confirmed evidence of fraud. Category two comprised 61 facilities with ongoing fraud cases, while category three had 105 cases closed by the KMPDC but holding contracts with SHA. Separately, the 998 files from KMPDC related to facilities operating in violation of the law.

Facilities under investigation have been accused of overbilling, falsifying records, converting outpatient visits to inpatient ones, and submitting claims for services delivered to non-existent patients. After receiving the files, DCI set up a multi-agency team to investigate assets and resources acquired through fraudulent means.

Despite the ongoing investigations, the government has raised concerns over the rise of unnecessary Caesarean section (C-section) deliveries motivated by profit. Speaking in Tharaka Nithi on Tuesday, December 16, during a strategic health engagement, Duale cited a case at a private hospital where 93 of 100 women delivering underwent C-sections.

“A C-section is reimbursed at Sh30,000 while a normal delivery attracts Sh10,000. So women are being operated on because of money. No, we will not agree to this,” he said.

The CS warned that the government would not tolerate exploitation of patients or misuse of public health funds. He also highlighted fraudulent use of SHA insurance cards, including attempts to use cards belonging to deceased relatives.

Duale commended a Nairobi hospital for reporting an attempt to use a relative’s card, stressing that cooperation with authorities is crucial.

“There is a squad within the DCI that deals specifically with medical fraud. There is a serious social problem in Kenya when it comes to integrity. You cannot eat money meant for patients. We will not accept it,” he said.

Duale reaffirmed the government’s commitment to cracking down on medical fraud, ensuring SHA benefits reach intended beneficiaries, and protecting patients from unethical medical practices.

SHA fraud has been a major challenge to the government’s health insurance programme, prompting measures such as the suspension of over 40 healthcare facilities and the closure of more than 1,000 non-compliant facilities nationwide in August 2025.

During the Tharaka Nithi engagement, the ministry urged locals to register under SHA. Since its inception in 2023, the authority has registered over 27 million Kenyans as of November 2025, with rapid growth driven by expanded benefits, mandatory service requirements and government rollout initiatives.