In a major escalation of the country’s war against corruption in the health sector, Health Cabinet Secretary (CS) Aden Duale on Monday handed over 1,188 case files to the Directorate of Criminal Investigations (DCI), containing damning evidence of widespread fraud in the Social Health Authority (SHA) Fund.
The files, submitted on September 1,2025, are part of an ongoing probe into the misuse of public health insurance funds, with allegations ranging from forgery and ghost billing to unlicensed operations and systemic abuse of patient records.
According to the Ministry of Health, the submitted files include 190 compiled by SHA itself and an additional 998 files from the Kenya Medical Practitioners and Dentists Council (KMPDC).
These files detail various categories of violations: 24 health facilities have conclusive evidence of fraud; 61 are under active investigation; and 105 were previously flagged by KMPDC but continued to operate under SHA contracts.
The evidence reportedly includes falsified treatment records, upcoding of medical procedures, inflated billing, double-claim submissions, and the registration of non-existent patients for financial gain.
The immediate fallout has been swift. SHA has already suspended 85 health facilities pending investigation.
Separately, KMPDC has revoked licenses from 454 facilities and shut down 544 others for serious regulatory violations, including the employment of unqualified medical personnel and failure to meet basic operational standards.
These actions follow a months-long crackdown on rogue facilities, which has included the closure of over 100 hospitals since June 2025.
This coordinated clean-up effort also leverages technology.
The Ministry of Health has rolled out a real-time, AI-powered fraud detection system within the TaifaCare infrastructure.
The tool analyzes patterns in claims and billing data, helping detect fraudulent activity before payments are processed—one of the boldest innovations yet in the health sector’s accountability push.
CS Duale emphasized that the crackdown is not just about exposing fraud, but also about restoring integrity in the national health system.
He commended the joint effort by SHA, KMPDC, the Clinical Officers Council (COC), and the Ministry of Health, all of whom were instrumental in compiling the evidence dossiers.
The DCI, in turn, has formed a multi-agency task force to fast-track investigations and possible prosecutions.
Duale has made it clear that no one, regardless of status or connections, will be shielded from accountability.
This latest development builds on a series of previous enforcement actions.
In June, the Ministry ordered the closure of 31 hospitals involved in SHA-related fraud, including ghost billing and double-claims.
In July, 35 more hospitals were shut down for similar offenses.
In August, 40 additional facilities were suspended, and 12 health officials, including eight doctors, were referred for disciplinary action.
To date, SHA has rejected over Sh10.6 billion in fraudulent claims, with an additional Sh2.1 billion still under review.
With the DCI now in possession of the full case files, prosecutions and asset recovery efforts are expected to follow.
The public has been urged to contribute to the effort by reporting suspicious activity through SHA hotlines and DCI’s anonymous tip line.
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