The Directorate of Criminal Investigations (DCI) has opened a major investigation into fraud at the Social Health Authority (SHA) after receiving more than 1,000 case files.
On Monday, September 1, Health Cabinet Secretary Aden Duale handed over 1,188 files to the DCI, triggering the formation of a multi-agency team to fast-track the probe.
The files point to possible fraud involving individuals, health facilities, and other entities linked to SHA.
In a statement, the DCI confirmed the handover and said the team would carefully review the files with the goal of charging all those involved, regardless of their position or political ties.
The agency also noted that it would pursue recovery of assets acquired through fraudulent means and would issue regular updates on the investigations.
According to CS Duale, the files fall into three groups: 24 health facilities where fraud had already been confirmed, 61 facilities with ongoing cases, and 105 cases previously closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) but still linked to SHA contracts.
The KMPDC submitted 988 of the 1,188 files. Many of the facilities are accused of practices such as inflating bills, falsifying medical records, charging for procedures never done, and claiming for services to non-existent patients.
Under the Social Health Insurance Act, 2023, facility owners found guilty of knowingly defrauding SHA face fines of up to Ksh2 million, suspension, or removal from SHA’s list of approved providers.
Running unlicensed facilities or hiring unregistered medics could attract fines of up to Ksh10 million or jail terms of up to five years under the Medical Practitioners and Dentists Council Act.
The crackdown comes just days after KMPDC announced the closure of 544 health facilities and revoked licences for 454 hospitals nationwide for failing to meet SHA standards or operating illegally.
