Twelve health officials, including eight doctors, are under investigation for allegedly defrauding the Social Health Authority, Health Cabinet Secretary Aden Duale has said.
Speaking during a press briefing on Friday, Duale said the officials, drawn from Nairobi, Bungoma, and Kilifi, were implicated in schemes involving fraudulent billing and false patient claims.
Their cases have been referred to the Directorate of Criminal Investigations (DCI).
“Any doctor or health official involved in defrauding SHA will be held personally responsible,” Duale told reporters.
“We will hand over all the hospitals and the 12 health officials to the DCI for further investigations. Additionally, we have ordered the relevant regulatory bodies to cancel their licenses.”
The investigations are part of a wider crackdown in which the Ministry of Health has suspended 40 hospitals from the SHA programme.
Duale said the suspensions, which take effect immediately, will remain in force during the probe.
He cited common fraudulent practices, including the conversion of outpatient cases into inpatient ones, particularly in Nairobi and Homa Bay, and the submission of claims for “ghost patients.”
“In Mandera County, four different facilities submitted claims for the same patient who was only admitted to one facility,” he said.
Duale stressed that the government will surcharge the suspended facilities for any funds lost through fraud.
“These facilities will not receive any benefits from SHA during the investigation period, and we will recover the money lost,” he said.
The Ministry will publish the names of the suspended hospitals in a Gazette Notice once investigations are complete.
The crackdown comes amid growing concern over abuse of the SHA programme, which was set up to streamline access to healthcare funding and improve service delivery.
Duale warned that both private and public sector actors found culpable will face the full force of the law.
“This behaviour undermines the integrity of our health system and robs deserving Kenyans of essential services. We will not tolerate it,” he said.
