Panic and tension have gripped medical professionals after the Ministry of Health submitted 1,188 files and supporting evidence of alleged fraudulent healthcare facilities to the Directorate of Criminal Investigations (DCI) for investigations.
In a statement on Monday, September 1, the Health Cabinet Secretary Aden Duale said that the Social Health Authority (SHA) submitted 190 files, while the Kenya Medical Practitioners and Dentists Council (KMPDC) submitted 998 files.
The SHA files were divided into three categories according to Duale. Category 1 comprised 24 health facilities in which SHA had concluded evidence of fraud, category 2 comprised 61 facilities that had ongoing fraud cases, and category 3 had 105 cases that were closed by the KMPDC but also had contracts with the authority.
On the other hand, the 998 files submitted by KMPDC comprised facilities that were operating in violation of the law.
The facilities are accused by the ministry of several fraudulent practices, including billing for more costly procedures than what was truly performed, falsifying records, converting outpatient visits to inpatient ones, and submitting claims for services delivered to nonexistent patients.
"The Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC) have today submitted a total of 1188 files and supporting evidence to the Directorate of Criminal Investigations (DCI)—a major step in their joint fight against healthcare fraud," Duale stated.
"This action targets fraudulent and non-compliant healthcare facilities and individuals, marking a critical milestone in the ongoing effort to protect public funds and safeguard the integrity of Kenya's healthcare system," he added.
If found guilty of knowingly or fraudulently altering information to defraud SHA, according to the CS, owners of the healthcare facilities will face a fine of up to Ksh2 million, suspension, and removal from the register of empanelled providers, in accordance with Section 48(5) of the Social Health Insurance Act, 2023.
Individuals who will be found to be operating these facilities without the necessary licences or employing registered medical practitioners will face fines of up to Ksh10 million or imprisonment for a term not exceeding five years in line with Section 22 (4) and (5) of the Medical Practitioners and Dentists Council Act, CAP 253.
Duale further claimed that the ministry, in collaboration with SHA, KMPDC, DCI, and DHA, has established a multi-agency team that will reinforce the crackdown against fraudulent healthcare facilities and medical personnel across the country.
"Let me be clear: as previously warned, any facility, doctor, or patient involved in fraud is now under the jurisdiction of our criminal justice system and will be prosecuted to the fullest extent of the law," Duale stated.
The announcement comes just days after KMPDC announced the closure of 544 health facilities and the revocation of licences for 454 hospitals across the country after they violated SHA regulations.
In a gazette notice dated Friday, August 29, the KMPDC stated that the facilities were shut down or downgraded because they were unlicensed or unregistered, operating below required standards, and employing unlicensed practitioners.
