Twelve medical professionals, including eight doctors, are currently under investigation over allegations of defrauding the Social Health Authority (SHA). The individuals, who are based in Nairobi, Bungoma, and Kilifi counties, are suspected of engaging in fraudulent billing practices and submitting false patient claims. Their cases have been forwarded to the Directorate of Criminal Investigations (DCI) for further inquiry.
The crackdown is part of a broader move by the Ministry of Health aimed at restoring integrity within the SHA programme. As a result, 40 hospitals have been suspended from participating in the scheme. These suspensions, which took immediate effect, will remain in place pending the outcome of the investigations.
According to officials, some of the schemes involved the illegal classification of outpatient cases as inpatient to inflate claims. This malpractice was notably common in Nairobi and Homa Bay counties. In one case from Mandera, four different health facilities submitted claims for a single patient who had only been admitted to one of them.
Authorities have vowed to hold accountable any healthcare provider found guilty of such misconduct. Regulatory bodies have been instructed to revoke the licenses of the implicated medics, and a surcharge will be imposed on facilities involved in fraudulent activity. These institutions will not be entitled to receive any SHA benefits during the ongoing investigations, and steps will be taken to recover all misappropriated funds.
The Ministry of Health plans to publish the names of the suspended hospitals in an official Gazette Notice once the investigations are finalized. This move is intended to promote transparency and deter future abuse of the system.
The SHA was established to improve access to healthcare services and streamline funding, but recent cases of abuse have raised serious concerns. Authorities stress that fraud within the programme not only erodes public trust but also deprives vulnerable Kenyans of vital health services.
Both private and public sector players found culpable will face legal consequences. Government officials have reiterated a zero-tolerance stance on corruption within the healthcare sector, emphasizing that no individual or institution will be spared if found to have defrauded the system.
