DCI Takes Over 1,188 Healthcare Fraud Cases in Nationwide Crackdown

The Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC) have forwarded more than 1,000 files to the Directorate of Criminal Investigations (DCI) for probe.

Health Cabinet Secretary Aden Duale, in a Monday, September 1 statement, confirmed the move, indicating that it was part of the countrywide crackdown on fake and non-compliant health facilities.

“The Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC) has today submitted a total of 1188 files and supporting evidence to the Directorate of Criminal Investigations (DCI) – a major step in their joint fight against healthcare fraud. This action targets fraudulent and non-compliant healthcare facilities and individuals, marking a critical milestone in the ongoing effort to protect public funds and safeguard the integrity of Kenya’s healthcare system,” the statement read.

KMPDC revealed that out of the 1,188 files submitted, SHA contributed 190 while the council forwarded 998.

SHA divided the files into three categories: 24 facilities where investigators had already confirmed fraud, 61 facilities still under investigation, and 105 facilities that KMPDC had previously shut down but were still under contract with the Authority.

KMPDC’s submissions targeted facilities accused of operating outside the law.

“These submissions are a critical step in a multi-agency collaboration that will see the DCI investigate and prosecute those responsible,” the statement added.

According to KMPDC, the fraudulent schemes included inflating medical bills by converting outpatient visits into inpatient admissions, falsifying medical records, billing for procedures that were never performed, and filing claims for patients who did not exist.

“SHA, in line with its mandate, has suspended a total of Eighty-Five (85) health facilities for fraudulent activities to allow for investigations. The rigorous forensic audits and digital system have uncovered deeply troubling patterns of fraud that directly harm the public and deplete the monies meant for patients.

KMPDC, for its part, and in line with its mandate, has conducted extensive inspections, which recently resulted in the closure of 544 Health Facilities for being unregistered or unlicensed and revocation of operating licenses of 454 health facilities due to a range of violations, including operating below required standards, employing unlicensed practitioners, and lacking critical infrastructure, posing a direct threat to patient health,” the statement further read.

KMPDC added that SHA had also taken action against individual practitioners connected to fraudulent schemes.

“SHA has already withdrawn user rights for 12 healthcare professionals implicated in criminal schemes and will be surcharging facilities to recover any monies paid based on fraudulent claims. We have a duty to pay only for services legitimately rendered and to hold those who seek to defraud the system accountable,” the statement concluded.

This development came just days after KMPDC shut down 158 health facilities in Nairobi for non-compliance.

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