Moments after receiving over 1,000 files detailing perpetrators of fraud within the Social Health Authority (SHA), the Directorate of Criminal Investigations (DCI) formed a multi-agency team to handle the cases expeditiously.
In a statement released on Monday, September 1, DCI confirmed receipt of 1,188 files from Health Cabinet Secretary Aden Duale, adding that a probe was underway to ensure all individuals implicated in the fraud were brought to book.
The files reportedly involve individuals, entities, and various parties suspected of engaging in health care fraud, particularly within SHA.
“The Directorate of Criminal Investigations (DCI) wishes to inform the public that it has today received 1,188 files from the Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC),” DCI stated.
“Upon receipt of the files, a multi-agency team has been constituted under the leadership of the DCI with a view to expeditiously reviewing the files. The objective of this review is to make sure that all those who have been involved in any form of healthcare fraud will be arraigned regardless of their social status and political affiliations,” it added.
Aside from the multi-agency team, DCI also noted that they would seek to recover assets and other resources acquired through fraudulent means and assured the public of regular updates on the progress of the investigations.
Duale Hands Over SHA Files
On Monday, CS Duale handed the files to the DCI as the crackdown on alleged fraud at the Health Ministry intensified. According to Duale, SHA files were divided into three categories. Category 1 comprised 24 health facilities in which SHA had concluded evidence of fraud, Category 2 comprised 61 facilities with ongoing fraud cases, and Category 3 comprised 105 cases that were closed by the KMPDC but also had contracts with the authority.
KMPDC, which submitted 988 out of the 1,188 files, provided details of 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 those actually performed, falsifying records, converting outpatient visits to inpatient ones, and submitting claims for services delivered to non-existent patients.
If found guilty of knowingly or fraudulently altering information to defraud SHA, 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 found to be operating these facilities without the necessary licences or employing unregistered 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.
The announcement came 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.
