1,188 Fraudulent Health Claims Files Handed to DCI for Probe

Health CS Aden Duale and senior officials display files of health facilities accused of fraudulent claims during the handover of 1,188 cases to the DCI for investigation.

Health Cabinet Secretary Aden Duale has announced that 1,188 files have been submitted to the Directorate of Criminal Investigations (DCI) for investigations into fraudulent claims under the Social Health Authority (SHA).

Out of these, 190 files were presented by SHA, broken down into three categories: 24 facilities with confirmed fraud, 61 with cases still under investigation, and 105 facilities previously closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) but still contracted with SHA.

Separately, the KMPDC submitted 998 files involving health facilities accused of operating illegally. The implicated facilities are suspected of engaging in fraudulent practices, including upcoding, falsifying records, converting outpatient visits into inpatient claims, and billing for patients who never existed.

Under Section 48(5) of the Social Health Insurance Act, 2023, those found guilty face penalties ranging from fines of up to Ksh2 million to suspension or outright removal from SHA’s provider register.

To intensify the crackdown, a multi-agency team comprising SHA, KMPDC, DCI, and the Digital Health Authority has been formed. The move is aimed at safeguarding Kenyans from exploitation and strengthening accountability in the country’s healthcare system.

Reporting by: Babz Abdul Raheem N.
Date: September 1, 2025