In a decisive move to safeguard public funds and restore integrity to Kenya’s healthcare system, Health Cabinet Secretary Aden Duale announced on Monday, September 1, 2025, that over 1,180 files detailing widespread fraudulent activities have been submitted to the Directorate of Criminal Investigations (DCI) for prosecution. This aggressive crackdown follows an intensive forensic review and a comprehensive digital audit that has already led to the closure of numerous implicated health facilities.
The submitted files, totaling 1,188, represent a collaborative effort between the Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC). The SHA contributed 190 files, while the KMPDC provided 998, highlighting the extensive nature of the non-compliance and fraudulent practices plaguing the sector. “This action targets fraudulent and non-compliant healthcare facilities and individuals, marking a key milestone in the ongoing effort to protect public funds and safeguard the integrity of Kenya’s healthcare system,” Duale stated at Afya House in Nairobi.
The fraudulent schemes uncovered are diverse and deeply troubling, including “upcoding” where facilities bill for more expensive procedures than those actually performed, falsification of patient records, converting routine outpatient visits into higher-rate inpatient claims, and “phantom billing” for services never rendered, often for non-existent patients. Some facilities, dubbed “ghost hospitals,” were found to be entirely non-existent or operating far below their claimed capacity, yet receiving substantial payments from SHA.
Health CS Aden Duale hands 1,188 health fraud files to DCI after ministry audit.
SHA has already suspended 85 facilities to allow for investigations, citing manipulated billing practices and claims for services provided to non-existent patients. KMPDC has also intensified its inspections, shutting down 544 unregistered or unlicensed facilities and revoking licenses for 454 others that operated below required standards or employed unlicensed practitioners.
Duale emphasized the role of technology in this fight, revealing that Kenya now employs a comprehensive digital system powered by artificial intelligence and a big data fraud engine. “Every transaction made by patients, doctors or facilities is recorded in real time. This system gives us the power to detect, analyse patterns, and stop fraudulent transactions,” he explained. This AI-powered system has already flagged anomalies, including claims from facilities with zero verifiable patient records or physical addresses leading to abandoned sites.
A multi-agency team comprising officers from the DCI, Ministry of Health, SHA, KMPDC, and the Digital Health Agency (DHA) has been formed to review these cases and ensure all perpetrators face the full force of the law, regardless of their social status or political affiliations.
Legal consequences for such fraud are severe, with fines up to Sh2 million, suspension, or removal from the register of empanelled providers under the Social Health Insurance Act, 2023, and fines up to Sh10 million or imprisonment for up to five years under the Medical Practitioners and Dentists Council Act for operating without licenses or employing unregistered practitioners.
SHA has already withdrawn user rights for 12 healthcare professionals implicated in criminal schemes and is pursuing recovery of fraudulently obtained fund.
The Ministry urges the public to remain vigilant and report any suspected fraudulent activities through SHA’s toll-free number 147 or the DCI’s toll-free number 0800 722 203.
