A hospital director from Kakamega County has been charged in court over an alleged scheme to defraud the Social Health Authority (SHA) of Ksh2.5 million, in a case that underscores the government’s widening crackdown on fraud in the healthcare sector.
According to the Directorate of Criminal Investigations (DCI), the director is accused of submitting fake medical claims to SHA by manipulating health-related documents. Investigators told the court that the suspect allegedly fabricated false information and altered medical records to support claims for services that were either not offered or not authorised.
Court proceedings further revealed that the hospital involved had neither been approved nor engaged to provide inpatient and maternal health services. Despite this, claims linked to such services were allegedly submitted to SHA and paid out, a move prosecutors say points to deliberate misrepresentation designed to exploit weaknesses in the claims processing system.
The accused appeared before the Milimani Law Courts, where he was charged with several offences, including obtaining money by false pretences under Section 313 of the Penal Code, falsification of health documents contrary to Section 48(5) of the SHA Act, and acquiring and using proceeds of crime under the Proceeds of Crime and Anti-Money Laundering Act. He denied all the charges when they were read out in court.
In his defence, the suspect’s lawyer urged the court to grant him bond, arguing that he is not a flight risk and had fully cooperated with investigators during his arrest. The defence also raised health concerns, telling the court that the accused is diabetic and may not receive proper dietary care while in custody.
After listening to submissions from both sides, the court directed that a bail report be prepared. The judge said a ruling on bond and bail terms will be delivered on Monday. Pending that decision, the suspect was remanded at Industrial Area Prison.
The case comes amid intensified investigations into widespread fraud targeting the Social Health Authority following the transition from the former NHIF system. Authorities say they have uncovered schemes involving fake medical records, inflated bills, upcoding, double charging and claims for so-called “phantom patients” who never received treatment.
More than 40 health facilities across the country have already been suspended as investigations continue, with several doctors and clinical officers also losing access to the SHA platform.
The Ministry of Health and the DCI have warned that individuals and institutions found to be defrauding SHA will be prosecuted, noting that such practices threaten the sustainability of universal healthcare. To stem the abuse, the government is rolling out measures including biometric verification and tighter audits as it seeks to restore public confidence in the national health financing system.