The Social Health Authority (SHA), in collaboration with the Kenya Medical Practitioners and Dentists Council (KMPDC) and the Clinical Officers Council (COC), has handed over 1,188 files to the Directorate of Criminal Investigations (DCI) for further action. The files reportedly contain detailed evidence against healthcare facilities and individuals accused of fraudulent and non-compliant practices.
This submission is the result of weeks of forensic audits and digital system checks that revealed deeply troubling activities in the health sector. The move marks a major milestone in the government’s intensified efforts to protect public funds and safeguard the integrity of Kenya’s healthcare system.
According to the Ministry of Health, the evidence presented to the DCI is strong enough to support prosecutions. Officials emphasized that healthcare fraud directly undermines public trust, drains scarce resources, and ultimately harms patients who rely on these services.
In line with its mandate, SHA has already suspended 85 health facilities implicated in the alleged fraud to pave the way for investigations. These facilities are said to have engaged in schemes that illegally diverted public resources meant to improve access to quality healthcare.
Three main fraudulent practices were highlighted. The first is upcoding, where health facilities billed for more expensive procedures than those actually carried out. The second involves falsification of medical records, with hospitals and clinics submitting altered or entirely false documentation to receive higher payments. The third scheme is the conversion of outpatient to inpatient cases, in which simple outpatient visits were illegally billed as inpatient admissions to maximize claims.
Authorities stressed that such practices will not be tolerated, adding that the crackdown forms part of a broader initiative to enhance accountability in the health sector. By ensuring that funds are properly managed, the government aims to restore public confidence in healthcare institutions and guarantee that resources reach the patients who need them most.
The ongoing investigations are expected to expose systemic weaknesses while deterring future malpractice. The collaboration between SHA, KMPDC, and COC demonstrates a unified approach to cleaning up the health sector. Moving forward, stricter monitoring mechanisms, digital tracking systems, and enhanced compliance checks are anticipated to ensure greater transparency and efficiency.
This unprecedented crackdown is being viewed as a turning point in the fight against healthcare fraud in Kenya, signaling a firm commitment to protect citizens and preserve the integrity of public health resources.
