Health Cabinet Secretary (CS) Aden Duale has formally handed over 1,188 case files and supporting evidence to the Directorate of Criminal Investigations (DCI) for further investigation and prosecution.
In a statement on September 1, Duale said the Social Health Authority (SHA) submitted 190 files, while the Kenya Medical Practitioners and Dentists Council (KMPDC) submitted 998 files totalling 1,188.
“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,” Duale said.
Duale said the SHA files were divided into three categories.
The first category 1 consisted of 24 health facilities in which the SHA had concluded evidence of fraud.
Category 2 comprised 61 facilities with ongoing fraud cases, while Category 3 covered 105 cases that were closed by KMPDC but still had contracts with SHA.
The files submitted by KMPDC comprised facilities that were operating in violation of the law.
The Ministry of Health stated that the move marked a significant milestone in the government’s efforts to safeguard public funds and maintain integrity in the healthcare system.
The Ministry stated that the handover follows an intensive forensic review and a comprehensive digital audit, which led to the closure of 1,300 health facilities implicated in fraudulent or non-compliant practices.
Offences uncovered include upcoding, falsification of records, conversion of outpatient services into inpatient claims, and phantom billing.
Also Read: Ruto Orders Hospitals Shut Down Over SHA Fraud to Refund Money
Duale Forms Investigation Team
Duale announced the creation of a multi-agency investigation team to strengthen accountability.
The Team comprises officers from the DCI, Ministry of Health, Social Health Authority (SHA), Kenya Medical Practitioners and Dentists Council (KMPDC), and the Digital Health Agency (DHA).
Duale said the team will ensure that all offenders, whether health facilities, providers, or patients, face the full force of the law.
Additionally, it will expedite the recovery of public funds and accelerate the rollout of Universal Health Coverage (UHC).
“Let me be clear: as previously warned, any facility, doctor, or patient involved in fraud is now under the jurisdiction of our criminal justice system and will be prosecuted to the fullest extent of the law,” Duale said.
Also Read: Church Denies, State Insists: Mudavadi Hits Back with SHA Records
AI Anti-Fraud Detector System
CS Duale also highlighted the Ministry’s cutting-edge AI-powered fraud detection system, built on a big data engine under TaifaCare.
The system monitors every transaction in real time, detecting suspicious patterns and blocking fraudulent claims before disbursement.
He urged Kenyans to support the crackdown by reporting suspected fraud through SHA’s toll-free line 147.
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