Fear has gripped medical circles after Health Cabinet Secretary Aden Duale confirmed that 1,188 files of suspected fraudulent healthcare facilities have been handed over to the Directorate of Criminal Investigations (DCI) for probe.
Speaking on Monday, September 1, Duale revealed that the Social Health Authority (SHA) submitted 190 files, while the Kenya Medical Practitioners and Dentists Council (KMPDC) submitted 998 files exposing facilities allegedly involved in illegal operations and healthcare fraud.
According to the CS, SHA’s files were classified into three categories:
- 24 facilities where fraud had been confirmed,
- 61 facilities with ongoing fraud investigations,
- 105 cases that were previously closed but still tied to SHA contracts.
The 998 KMPDC files flagged hospitals accused of operating in violation of the law. Some of the shocking allegations include:
- Charging for expensive procedures never carried out,
- Falsifying medical records,
- Converting outpatient visits into inpatient cases,
- Billing for treatment of patients who do not exist.
“This action targets fraudulent and non-compliant healthcare facilities and individuals, marking a critical milestone in protecting public funds and safeguarding the integrity of Kenya’s healthcare system,” Duale declared.
If found guilty, rogue hospital owners could face fines of up to Ksh2 million, suspension, and removal from SHA’s list of approved providers under the Social Health Insurance Act, 2023.
Meanwhile, those running unlicensed facilities or employing unregistered practitioners risk fines of up to Ksh10 million or jail terms of up to 5 years under the Medical Practitioners and Dentists Council Act.
Duale further announced a multi-agency crackdown involving SHA, KMPDC, DCI, and DHA to ensure fraudsters in the health sector are prosecuted.
The bombshell comes just days after KMPDC shut down 544 hospitals and revoked licences for 454 more across the country for flouting SHA rules.
