The Directorate of Criminal Investigations (DCI) has intensified its nationwide crackdown on alleged fraud within the Social Health Authority (SHA), confirming that proprietors and directors of 30 health facilities will soon face prosecution pending approval from the Office of the Director of Public Prosecutions (ODPP).
According to a DCI report dated April 2, investigators have concluded that the facilities have “a case to answer” following forensic audits linked to 260 fraud complaints submitted by SHA. The findings point to widespread irregularities in claims submitted under the national health insurance system.
Out of the 260 cases under review, 30 case files have already been forwarded to the ODPP for approval to charge the suspects in court. The report further indicates that 68 suspects and facilities have already been charged and are facing ongoing court proceedings, while charges against 19 others have been approved.
Some suspects have reportedly sought conservatory orders or opted for alternative dispute resolution mechanisms, including refunding irregular payments made by SHA, as investigations continue.
Among those already facing prosecution are former National Hospital Insurance Fund (NHIF) Chief Executive Officer Elijah Wachira and former acting SHA CEO Robert Ingasira. The two are among 50 individuals charged over alleged fraudulent claims linked to the authority.
They were charged alongside directors of Archprime Medical Clinic over accusations of falsifying medical records and handling proceeds of crime amounting to Ksh.17.5 million.
In a separate case, ICT officer Harun Liluma from the Kenya Medical Practitioners and Dentists Council (KMPDC) has also been charged over alleged fraudulent registration of eight medical facilities and unlawful receipt of SHA funds. Investigators say Liluma, together with 15 facility directors, allegedly received Ksh.30.7 million irregularly.
The DCI report identifies Mandera County as one of the worst affected regions, with 51 facilities flagged and suspended over alleged fraudulent claims. The facilities are accused of falsifying documents, inflating inpatient claims, submitting fake or non-existent facilities, and operating with fraudulently acquired licenses.
Despite the scale of the allegations, Health Cabinet Secretary Aden Duale maintains that no public funds have been lost. He stated that SHA’s digital verification system has significantly reduced fraud levels, saying, “We have reduced fraud from over 36% when I became the minister to about 6%.”
The government has warned that all individuals and facilities implicated will face legal action as efforts continue to safeguard Universal Health Coverage and restore integrity in the healthcare system.
