A hospital director from Kakamega County has been charged with defrauding the Social Health Authority (SHA) of Ksh2.5 million through the alleged submission of fake medical claims, in a case that points to the growing crackdown on fraud within the healthcare sector.
According to the Directorate of Criminal Investigations (DCI), the suspect is accused of manipulating health-related documents that were presented to SHA to support fraudulent claims. Investigators say the director fabricated false representations and altered medical records to unlawfully obtain the funds.
Earlier court proceedings further revealed that the hospital in question had not been authorised or contacted to offer inpatient and maternal health services, yet claims linked to such services were allegedly submitted and paid out.
Prosecutors argue that this points to deliberate misrepresentation aimed at exploiting weaknesses within the claims processing system.
The accused faces multiple charges, including obtaining money by false pretences under Section 313 of the Penal Code, falsification of health documents contrary to Section 48(5) of the SHA Act, and acquiring and using proceeds of crime under the Proceeds of Crime and Anti-Money Laundering Act. He denied all charges when they were read in court.
In mitigation, the defence told the court that the accused was not a flight risk, noting that he did not resist arrest and had cooperated with investigators. His lawyer also raised health concerns, stating that the suspect is diabetic and may not receive proper dietary care while in custody, urging the court to grant him bond.
After hearing submissions from both the prosecution and the defence, the court ordered that a bail report be prepared. The judge said a ruling on bond and bail terms would be delivered on Monday. In the meantime, the suspect was remanded at Industrial Area Prison.
The case comes amid intensified investigations into widespread fraud targeting the Social Health Authority, following the transition from the former NHIF system.
Authorities have uncovered patterns involving fake medical records, inflated billing, upcoding, double charging, and claims for “phantom patients” who never received treatment.
More than 40 health facilities across the country have previously been suspended as investigations continue, with several doctors and clinical officers also losing access to the SHA platform.
The Ministry of Health and the DCI have warned that individuals and facilities involved in defrauding SHA will face prosecution, stressing that such practices threaten the sustainability of universal healthcare.
Measures including biometric verification and tighter audits are being rolled out to curb abuse, as the government seeks to restore public trust in the national health financing system.
