Nairobi, Kenya – Proprietors and directors of 30 health facilities could soon face prosecution over fraud allegations linked to the Social Health Authority (SHA), pending approval from the Office of the Director of Public Prosecutions (DPP).
The Directorate of Criminal Investigations (DCI) says findings from ongoing investigations and forensic audits indicate that the facilities have a case to answer, marking a significant escalation in the crackdown on healthcare fraud.
According to a report dated April 2 by the DCI, a total of 260 fraud complaints have been lodged by SHA. Out of these, 30 case files have already been forwarded to the DPP for approval.
Already, 18 health facilities and 50 individuals are before the courts facing fraud-related charges, while 68 suspects and entities have active cases pending. Charges against 19 others have also been approved, with some suspects opting for alternative dispute resolution and refunding overpayments to SHA.
Among those facing charges are former NHIF Chief Executive Officer Elijah Wachira, who later served as SHA CEO, and former acting SHA CEO Robert Ingasira. The two are accused, alongside directors of Archprime Medical Clinic, of falsifying medical records and handling proceeds of crime amounting to Ksh.17.5 million.
In a separate case, an ICT officer at the Kenya Medical Practitioners and Dentists’ Council (KMPDC), Harun Liluma, has been charged with fraudulently registering eight medical facilities and facilitating unlawful payments from SHA.
“The officer, together with 15 directors from the eight facilities, unlawfully received Ksh.30.7 million from SHA,” the DCI report states.
The implicated facilities primarily based in Mandera County include Danaba Care Hospital, Kamsihawa Medical Centre, Kaafi Nursing Home, Mama Nerbeel Nursing Home, Alati Nursing Home, Julun Nursing Home, Adfaal Kids Care Medical Centre, and Dimtu Nursing Home Limited.
Mandera has emerged as a hotspot in the investigations, with 51 facilities flagged and suspended over suspected fraudulent activities.
The DCI outlined multiple fraud schemes, including falsification of documents, conversion of outpatient cases into inpatient claims, submission of claims by non-existent facilities, and operations under fraudulently acquired licenses.
Despite the scale of the allegations, Health Cabinet Secretary Aden Duale maintained that public funds remain safeguarded under SHA systems.
“The SHA is anchored under a very robust digital system that detects patients, doctors, facilities the whole healthcare spectrum and we have reduced fraud from over 36% to about 6%,” said Duale.
He added that the authority has successfully rejected fraudulent claims amounting to over Ksh.12.7 billion.
“We will take all necessary action to ensure the success of Universal Health Coverage,” the CS warned, cautioning facilities, healthcare workers, and patients against engaging in fraud.
The unfolding cases highlight ongoing challenges within Kenya’s healthcare financing system, even as authorities push reforms aimed at strengthening accountability and achieving universal health coverage.
