Owners and Directors of 30 Hospitals Face Looming Charges as SHA Fraud Crackdown Intensifies

Directors and owners of about 30 health facilities may soon be taken to court for suspected fraud if the Director of Public Prosecutions (DPP) approves the charges.

Investigations by the Directorate of Criminal Investigations (DCI) into fraud complaints linked to the Social Health Authority (SHA), alongside a forensic audit of facility transactions, found that the facilities have cases to answer.

Already, 18 facilities and 50 individuals are before court facing fraud-related charges.

A report released by the DCI Director, dated April 2, outlines the status of 260 fraud complaints lodged by the Social Health Authority.

According to the report, 30 case files have already been submitted to the Office of the Director of Public Prosecutions for approval to proceed with charges.

In total, 68 suspects and facilities have been charged, and their cases are currently pending in court. The DPP has also approved charges against 19 others.

Some suspects have sought conservatory orders or opted for alternative dispute resolution mechanisms, with several facilities refunding overpayments made by the SHA.

Also Read: SHA Suspends Bungoma West Hospital for 90 Days as Aden Duale Warns Facilities

Former SHA and NHIF Officials Among Those Charged

Among those whose cases are already pending in court are former NHIF Chief Executive Officer Elijah Wachira, who later served in the same capacity at the Social Health Authority, and former acting SHA CEO Robert Ingasira.

The two are among 50 individuals charged over alleged fraudulent claims involving the Social Health Authority.

They were charged alongside two directors of Archprime Medical Clinic over accusations of falsifying medical records and using proceeds of crime amounting to Ksh 17.5 million.

ICT Officer Linked to Fraudulent Facility Registrations

An ICT officer at the Kenya Medical Practitioners and Dentists’ Council (KMPDC), Harun Liluma, is also among those charged.

Liluma faces charges related to the fraudulent registration of eight different medical facilities and allegedly receiving unlawful payments from the Social Health Authority.

According to the DCI, the KMPDC officer, together with 15 directors from the eight facilities, unlawfully received Ksh 30.7 million from SHA.

The facilities implicated include: Danaba Care Hospital, Kamsihawa Medical Centre, Kaafi Nursing Home, Mama Nerbeel Nursing Home, Alati Nursing Home, Julun Nursing Home, Adfaal Kids Care Medical Centre, and Dimtu Nursing Home Limited—all located in Mandera County.

These facilities are among the 19 that have already received approval from the Office of the Director of Public Prosecutions for prosecution.

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Mandera County Flagged as Fraud Hotspot

The DCI report identified Mandera County as one of the leading regions in fraudulent claims, with 51 health facilities flagged and suspended.

The facilities are accused of multiple fraudulent practices, including falsification of documents, conversion of outpatient cases into inpatient claims, forgery of records to demand extra payments, receipt of payments without signed contracts with the SHA, submission of claims from non-existent facilities, and operation under fraudulently acquired KMPDC licenses.

Government Insists No Public Funds Lost

Health Cabinet Secretary Aden Duale maintained that no public funds have been lost under the Social Health Authority system.

“The SHA is anchored under a very robust technology digital system that detects patients, doctors, facilities, the whole spectrum of the healthcare system in our country, and we have reduced fraud from over 36% when I became the minister to about 6%,” Duale said.

The CS warned health facilities, healthcare workers, and patients that the government will take all necessary action to ensure the success of the Universal Health Coverage programme.

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Health CS Aden Duale during a past meeting. PHOTO/MoH