The Ministry of Health has escalated its crackdown on healthcare fraud, handing over 1,188 cases of non-compliant and fraudulent facilities to the Directorate of Criminal Investigations (DCI).
Health Cabinet Secretary Aden Duale said on Monday that the files were submitted by the Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC), marking a major step in safeguarding public funds and patient safety.
Of the cases, SHA submitted 190 files linked to fraudulent billing, falsified records, phantom patients, and illegal conversions of outpatient visits into inpatient claims.
Already, 85 facilities have been suspended, and 12 healthcare professionals have lost user rights on suspicion of criminal involvement.
KMPDC forwarded 998 files involving facilities found to be unlicensed, poorly equipped, or operating with unqualified staff. In recent inspections, the council closed 544 health facilities and revoked the licenses of 454 others.
“This is a clear warning,” Duale said. “Any facility, doctor, or patient involved in fraud will now face prosecution. We will only pay for services legitimately rendered.”
The ministry has also deployed an AI-powered fraud detection system under TaifaCare, which tracks transactions in real time and flags suspicious claims.
Under current law, those found guilty risk fines of up to Ksh10 million, jail terms of up to five years, and permanent removal from the healthcare register.
Duale urged Kenyans to report suspected fraud through SHA’s toll-free line 147, saying public vigilance is crucial in protecting the country’s health system