Eight individuals and a health facility have been charged with the fraudulent acquisition of over Ksh7 million from the Social Health Authority as the government continues to crack down on malpractice within hospitals.
In a case brought forward by the Office of the Director of Public Prosecutions (ODPP), the suspects faced a range of charges including conspiracy to commit a felony, fraudulent alteration and falsification of records, acquisition and use of proceeds of crime, cheating, forgery, uttering false documents and falsification of health records.
According to court documents, the charges stem from two separate alleged schemes involving health facilities in Kilifi and Vihiga counties.
In the first case, directors and staff affiliated with a private clinic in Mtwapa, Kilifi County, were accused of conspiring to falsify medical information between November 1 2024 and June 30, 2025.
The ODPP believes these fraudulent records led to irregular payments from SHA, totalling Ksh2 million.
In a separate incident, an employee attached to a facility in Vihiga County was accused of defrauding SHA of more than Ksh5.1 million over a similar period.
The accused persons appeared at the Milimani Law Courts before Chief Magistrate Lucas Onyina, where they denied all charges. All suspects were released on a bond of Ksh600,000 pending further court proceedings.
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 there was evidence of fraud, Category 2 comprised 61 facilities that had ongoing fraud cases, and Category 3 comprised 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.
Earlier, in August, Duale noted that fraudulent practices in the healthcare sector were a growing global challenge, accounting for up to 15 per cent of expenditures. In Kenya, the Association of Kenya Insurers (AKI) estimates that 30 per cent of medical payouts are linked to fraudulent claims.
A renewed audit from the government led to the closure of 728 non-compliant facilities and the downgrading of 301 others by the Kenya Medical Practitioners and Dentists Council (KMPDC). In June, SHA also suspended 40 facilities following forensic audits and announced plans to degazette an additional 45 flagged for fraudulent activities.
