DCI Forms Multi-Agency Team to Probe 1,188 Healthcare Fraud Files

The Directorate of Criminal Investigations (DCI) has formed a multi-agency team to fast-track investigations into 1,188 healthcare fraud files submitted to them on Monday by the Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC).

Health Cabinet Secretary Aden Duale stated that the crackdown targets fraudulent and non-compliant healthcare facilities and individuals who have been siphoning funds intended for patients.

SHA has already suspended 85 health facilities linked to suspicious activities.

“The forensic audits and digital systems have uncovered deeply troubling patterns of fraud that directly harm the public and drain resources from patients,” said CS Duale.

The Ministry of Health has revealed that the fraud involved practices such as upcoding, where costs of treatment were inflated, falsifying medical records, converting outpatient cases into inpatient cases, and billing for services that were never offered.

Last week, the Kenya Medical Practitioners and Dentists Council (KMPDC) closed 544 health facilities and cancelled 454 licences in the ongoing crackdown.

Of the files submitted to the Directorate of Criminal Investigations (DCI), the Social Health Authority (SHA) provided 190. These included 24 cases with already concluded evidence of fraud, 61 that are still under investigation, and 105 involving facilities that were closed by KMPDC but remained contracted by SHA. On its part, KMPDC submitted 998 files involving facilities found to be operating in violation of the law.

Health Cabinet Secretary Aden Duale reminded providers that the law prescribes stiff penalties for fraudulent practices. Under the Social Health Insurance Act, 2023, offenders risk fines of up to Sh2 million, suspension, or removal from the register of approved providers. SHA has already revoked the access rights of 12 healthcare professionals linked to fraud and has initiated recovery of funds paid through false claims.

In addition, under the Medical Practitioners and Dentists Council Act, unlicensed facilities or those employing unregistered doctors face fines of up to Sh10 million or jail terms of up to five years.

The DCI confirmed receiving the files and said no one will be spared.

“A multi-agency team has been constituted under the leadership of the DCI to review the files expeditiously. Those involved, regardless of social status or political affiliation, will be arraigned,” the DCI said in a statement.

The agency further promised to recover all assets acquired fraudulently and keep the public updated on the progress.