The Directorate of Criminal Investigations (DCI) has exposed a large-scale fraud scheme involving healthcare providers, including clinics previously shut down by regulators, fraudulently claiming millions of shillings from Kenya’s Social Health Authority (SHA).

On July 28, 2026, the DCI announced that five individuals were arraigned at Milimani Law Courts after investigations revealed a coordinated effort to siphon public funds through false medical claims. This development follows a forensic audit initiated by the SHA that flagged numerous irregularities in claims submitted by contracted healthcare facilities.

Closed Clinics Continued to Claim Payments

The audit uncovered that some health facilities, previously closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) for regulatory breaches, remained active on the SHA system and continued submitting reimbursement claims. Investigators found evidence of fabricated patient admissions, falsified medical records, and false declarations aimed at obtaining unlawful payments.

Further probe indicates these providers operated outside the Social Health Insurance Act’s provisions yet processed claims as if fully compliant.

Financial Impact and Legal Action

  • One provider allegedly received over Ksh 38.7 million through fraudulent claims.
  • Another is suspected of unlawfully acquiring more than Ksh 2.5 million.
  • DCI intercepted suspicious claims worth over Ksh 8.1 million before payments were made, preventing further losses.

The accused face charges including conspiracy to commit felony, making false statements under the Social Health Insurance Act, and dealing in suspected proceeds of crime. They have denied the allegations, with the case ongoing in court.

Ongoing Investigations and Wider Crackdown

Investigations continue as the DCI pursues other individuals linked to the fraud network. This case is part of a broader crackdown on fraudulent claims under the SHA, which replaced the National Hospital Insurance Fund (NHIF) as Kenya’s public health insurer.

Earlier audits led to suspension or closure of dozens of health facilities involved in fraud such as billing for services not rendered, double billing, and use of phantom patients. Hundreds more facilities remain under review.

Health Cabinet Secretary Aden Duale has highlighted government efforts including digital audits and biometric verification devices deployed across SHA-contracted facilities to authenticate patient identities and reduce fraud.