Five Kenyans are set to appear in court on Monday to face charges relating to fraud at the Social Health Authority (SHA) involving fraudulent payment of hospital claims.
The Directorate of Criminal Investigations (DCI) confirmed the developments on Friday, revealing that, after weeks of comprehensive analysis and investigation into the files submitted by Health CS Aden Duale, they had identified the five individuals in question.
The DCI stated that a total of 1,188 files are at various stages of investigation and that additional suspects are set to be arrested pending the approval of the Office of the Director of Public Prosecutions (ODPP).
"We wish to inform the general public that the 1,188 files are at various stages of investigation. Currently, five suspects are in custody pending arraignment on Monday, October 6, 2025. Efforts to apprehend additional suspects are already underway, following approval from the ODPP," DCI stated.
"Thorough and expedient investigations were immediately initiated upon receipt of the files. A multi-agency team, led by the DCI, was formed to conduct a comprehensive review of the materials. The aim is to ensure that all individuals involved in any form of healthcare fraud are held accountable for their actions."
DCI added that the suspects will be arraigned on various charges, including offences under the Penal Code, the Proceeds of Crime and Anti-Money Laundering Act, the Social Health Insurance Act, and the Anti-Corruption and Economic Crimes Act.
On September 1, 2025, DCI received the 1,188 files from SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC) following widespread complaints by Kenyans over an alleged fraud that was ongoing within the health sector.
The files pertained to individuals and organisations believed to be involved in healthcare fraud, who are reported to have made sustained efforts to undermine government initiatives to provide quality healthcare services to the public.
The SHA files were divided into three categories according to Health CS Aden 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 were 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 non-existent patients.
Upon the receipt of the files, DCI set up a multi-agency team tasked with investigating the assets and other resources acquired through fraudulent means.
