The Ministry of Health has launched a crackdown on healthcare fraud, with Cabinet Secretary for Health, Hon. Aden Duale, announcing the submission of 1,188 fraudulent and noncompliant case files to the Directorate of Criminal Investigations (DCI) for prosecution.
The joint move by the Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC) marks the largest anti-fraud action yet under the country’s health reforms.
“This submission of evidence to the DCI is a critical next step in our fight against healthcare fraud,” CS Duale declared. “Any facility, doctor, or patient involved in fraud will face the full force of the law.”
Forensic audits and new digital fraud-detection systems uncovered widespread schemes that drained funds meant for patients. These include:
- Phantom billing for non-existent patients
- Falsified medical documents
- Charging for procedures never performed
- Converting outpatient visits into inpatient claims
- Employing unlicensed practitioners and operating substandard facilities
As part of the crackdown, SHA suspended 85 health facilities, while KMPDC shut down 544 unregistered facilities and revoked licenses for 454 others operating below standard.
Categories of Cases Submitted
- SHA: 190 facilities (24 with confirmed fraud, 61 under investigation, 105 already closed)
- KMPDC: 998 facilities violating licensing and operational laws
In addition, SHA withdrew system access for 12 healthcare professionals implicated in fraudulent schemes.
Under the Social Health Insurance Act 2023, offenders face fines of up to KSh 2 million, suspension, and deregistration. Meanwhile, violations of the KMPDC Act Cap 253 carry penalties of up to KSh 10 million or imprisonment of up to five years.
Duale noted that Kenya’s AI-powered big data fraud engine, rolled out with the TAIFA Care system, is enabling real-time detection of suspicious transactions.
“For the first time, every patient, doctor, and facility transaction is recorded in real-time. This system gives us the power to detect, analyse, and stop fraud before it drains resources,” he said.
Key Numbers at a Glance
- 1,188 case files handed to DCI
- 190 files from SHA (24 confirmed fraud, 61 under probe, 105 already closed)
- 998 files from KMPDC on illegal operations
- 85 facilities suspended by SHA
- 544 facilities shut down by KMPDC
- 454 licenses revoked
- 12 health professionals locked out of the SHA system
The CS urged Kenyans to remain vigilant and report suspicious activities via SHA’s toll-free line 147.
“We have a duty to protect patient rights and ensure quality services for all Kenyans. Your participation is vital to securing a healthier future for our nation,” Duale emphasized.
The Ministry confirmed that a multi-agency task-force comprising the DCI, Ministry of Health, SHA, KMPDC, and Clinical Officers Council will spearhead investigations and prosecutions.
