The Directorate of Criminal Investigations (DCI) has arraigned five directors of two healthcare facilities before the Milimani Law Courts over an alleged multi-million-shilling fraud targeting the Social Health Authority (SHA).

🇰🇪 Breaking It Down

The arrests followed a formal complaint lodged by SHA after a forensic audit uncovered widespread irregularities in medical claims submitted by several contracted healthcare providers.

According to investigators, the audit found that some healthcare facilities previously closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) for non-compliance continued to operate under active SHA contracts.

Detectives allege the suspects orchestrated fraudulent schemes involving fictitious medical claims, including claims for patients who were never admitted, falsified medical records, and false statements made to obtain payments from SHA.

📌 What You Need to Know

Investigations further revealed that some of the claims were allegedly submitted by facilities operating outside the requirements of the Social Health Insurance Act and other applicable regulatory frameworks.

The DCI said one of the healthcare facilities is suspected to have fraudulently received more than KSh38.7 million through the scheme, while the second facility allegedly obtained more than KSh2.5 million. Detectives also intercepted additional claims worth over KSh8.1 million before the payments were processed.

The five accused persons were charged with conspiracy to commit a felony, making false statements to obtain benefits under the Social Health Insurance Act, and the acquisition and use of proceeds of crime, contrary to the Proceeds of Crime and Anti-Money Laundering Act (POCAMLA).

The DCI said investigations are still ongoing and that detectives are pursuing additional suspects believed to be linked to the alleged fraud network.

The arraignment comes days after Health Cabinet Secretary Aden Duale warned that civil servants found colluding with rogue healthcare facilities to defraud SHA would face criminal prosecution.

Speaking during a visit to SHA headquarters, Duale said fraud, collusion with rogue healthcare providers and misuse of public funds would not be tolerated, warning that anyone found culpable would face the full force of the law.

📰 Source: Kenyans.co.ke