The Directorate of Criminal Investigations (DCI) has arraigned five directors linked to two healthcare facilities over an alleged fraud scheme targeting the Social Health Authority (SHA).
The suspects appeared before the Milimani Law Courts following investigations into fraudulent medical claims that are estimated to have cost the public health insurer tens of millions of shillings.
The case follows a formal complaint by SHA after a forensic audit uncovered widespread irregularities in claims submitted by several contracted healthcare providers.
The audit also revealed that some health facilities previously shut down by the Kenya Medical Practitioners and Dentists Council (KMPDC) for non-compliance had continued operating under active SHA contracts.
Investigations Uncover Alleged Fraudulent Claims
According to the DCI, investigations established that the suspects allegedly orchestrated fraudulent schemes involving fictitious medical claims, including billing for patients who were never admitted, falsified medical records, and false statements used to obtain payments from SHA.
Detectives further found that some claims were allegedly submitted by healthcare facilities operating outside the requirements of the Social Health Insurance Act and other applicable regulatory frameworks.
Investigators estimate that Nissi Medical Centre allegedly received more than Sh38.7 million through fraudulent claims. Dawa Front Healthcare Services is suspected to have fraudulently obtained more than Sh2.5 million, while detectives intercepted additional claims worth over Sh8.1 million before they were processed for payment.
Five Directors Face Multiple Charges
Before the Milimani Law Courts, the five accused persons faced several charges related to the alleged scheme.
The accused include Nissi Medical Centre directors Dominic Atieno and Peter Atieno, alongside Dawa Front Healthcare Services directors Eugine Ochieng, Enos Osire, and Elija Otieno.
The charges include conspiracy to commit a felony, making false statements to obtain benefits under the Social Health Insurance Act, and acquisition and use of proceeds of crime contrary to the Proceeds of Crime and Anti-Money Laundering Act (POCAMLA).
The DCI says investigations remain active, with detectives pursuing additional suspects believed to have played a role in the alleged fraud scheme.
The directorate reaffirmed its commitment to safeguarding public resources and protecting the integrity of Kenya’s healthcare financing system. It said individuals found to have exploited public health funds through fraudulent practices will be held accountable in accordance with the law as investigations continue.
