Five directors linked to two healthcare facilities have been charged in court following investigations into an alleged fraud scheme involving the Social Health Authority (SHA).
The Directorate of Criminal Investigations (DCI) said the suspects were arraigned before the Milimani Law Courts after investigations uncovered what detectives believe was a coordinated effort to obtain payments from the national health insurance system through irregular claims.
According to the DCI, the case began after SHA lodged a formal complaint following a forensic audit of medical claims submitted by several healthcare providers contracted under the scheme.
The audit reportedly revealed widespread irregularities and raised concerns about how some facilities were processing and submitting claims.
Investigators found that some healthcare facilities that had previously been closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) for failing to meet regulatory requirements were still operating under active SHA contracts.
This discovery prompted deeper investigations into the facilities and their claim records.
Detectives allege that the suspects were involved in submitting fraudulent medical claims, including claims for patients who had never been admitted to hospital.
Investigators also claim that falsified medical records were used and that false information was provided to secure payments from SHA.
Further investigations established that some of the claims were allegedly submitted by facilities that were operating outside the requirements set out under the Social Health Insurance Act and other relevant regulations governing healthcare providers.
The DCI stated that Nissi Medical Centre is suspected of receiving more than Sh38.7 million through fraudulent claims.
Dawa Front Healthcare Services is also under investigation over claims that it fraudulently obtained more than Sh2.5 million.
Detectives further reported that they managed to stop the payment of additional claims worth more than Sh8.1 million before the funds were released.
The five accused persons include Nissi Medical Centre directors Dominic Atieno and Peter Atieno.
Also charged are Dawa Front Healthcare Services directors Eugine Ochieng, Enos Osire, and Elija Otieno.
The suspects face several charges, among them 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 said investigations are still ongoing and that detectives are pursuing other individuals believed to have played a role in the alleged scheme.
Authorities have maintained that efforts to safeguard public funds and protect the integrity of the country’s healthcare financing system will continue as the case proceeds through the courts.
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