The Directorate of Criminal Investigations (DCI) has begun a wide-ranging probe into 1,188 case files linked to fraud within the Social Health Authority (SHA). The cases, involving individuals and health facilities, highlight alleged schemes that have undermined access to quality healthcare and drained vital public resources.
According to investigators, the files were submitted by oversight bodies overseeing healthcare services, raising serious concerns about malpractice across the sector. The review revealed that many of the implicated parties engaged in fraudulent activities designed to exploit the SHA system, limiting its ability to deliver effective and affordable medical care to Kenyans.
To address the scandal, a special multi-agency team has been formed to scrutinize the cases and ensure accountability. The team emphasized that no individual or institution will be spared, regardless of political influence or social standing. Authorities have pledged to prosecute offenders and pursue the recovery of assets obtained through fraudulent means.
The development follows a comprehensive digital audit and forensic review that exposed widespread fraud within the SHA. The audit identified over 1,300 health facilities that were either closed down or suspended for operating outside the required medical standards, being unregistered, or engaging in non-compliant practices. These facilities were flagged for submitting false claims, failing to meet service delivery requirements, or misusing funds allocated for patient care.
The findings paint a grim picture of systemic abuse within the healthcare system, where funds meant to support affordable medical services were diverted for personal gain. Officials have warned that such fraudulent practices not only compromise patient safety but also threaten the sustainability of universal health coverage in the country.
Of the total files submitted for investigation, 190 originated from SHA’s internal assessments, while 998 were forwarded by other medical regulatory bodies. Collectively, the cases reveal deep-seated irregularities that must be addressed if confidence in the public health insurance system is to be restored.
The DCI and partner agencies have vowed to accelerate the review process and bring offenders to justice. The ongoing probe is seen as a critical step toward cleaning up the healthcare sector and safeguarding resources earmarked for patient welfare. Authorities maintain that the crackdown will continue until all fraudulent activities within the SHA framework are fully addressed.
