The Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC) have handed over 1,188 files to the Directorate of Criminal Investigations (DCI) for investigation.
Ministry of Health CS Aden Duale confirmed the move terming it a major milestone in the fight against healthcare fraud.
Duale claimed the files contain evidence targeting fraudulent and non-compliant healthcare facilities and individuals.
“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.
The CS said the files submitted to the DCI contain detailed evidence to support prosecution.
Duale added that the move underscores the government’s commitment to curbing fraud in the health sector, protecting public funds, and restoring public trust in healthcare institutions.
According to the ministry, the submission follows weeks of joint action by SHA, KMPDC, and the Clinical Officers Council (COC).
The agencies have been carrying out forensic audits and digital system checks that uncovered deeply troubling practices in the health sector.
Duale revealed that SHA had already suspended 85 health facilities to pave way for investigations.
“SHA, in line with its mandate, has suspended a total of Eighty-Five (85) health facilities for fraudulent activities to allow for investigations,” he stated.
The CS noted that the fraudulent practices unearthed directly harm the public and drain resources meant for patients. He cited three main schemes used by rogue providers.
One was upcoding where facilities billed for more expensive procedures than what was actually performed.
Another was the falsification of records which involved submitting altered or false medical documents.
The third was the conversion of outpatient to inpatient where hospitals illegally billed for inpatient admissions in cases that were simple outpatient visits.
Duale stressed that such practices will not be tolerated. He said the crackdown is part of a broader effort to strengthen accountability in healthcare and ensure that resources are used to benefit patients, not unscrupulous actors.
