DPP reviews files in SHA probe targeting corrupt health facilities

Renson Ingonga, Director of Public Prosecution (DPP) before the Public Accounts Committee (PAC). (Elvis Ogina, Standard)

The Office of the Director of Public Prosecutions (ODPP) will have the final say on whether a number of suspects should be charged for fraudulently pocketing millions from the Social Health Authority (SHA) under the guise of offering treatment to patients.

This after the Directorate of Criminal Investigations (DCI) forwarded 18 case files to the office for review and legal advice.

The files are part of an ongoing probe into irregular payments by SHA, which is suspected to have lost billions in fictitious claims by health facilities in Nairobi, Homa Bay, Wajir, Kilifi, Kakamega, Bungoma, Busia, Kisumu, Vihiga, and Kajiado counties.

In mid-August, the Ministry of Health revealed that insurance claims worth Sh10.6 billion had been revoked, with an additional Sh13.3 billion still under scrutiny, raising concerns that taxpayers could lose up to Sh24 billion in a scheme created to cure corruption witnessed at the defunct National Health Insurance Fund (NHIF).

Following public uproar, Health Cabinet Secretary Aden Duale succumbed to pressure and handed over 1,188 files containing “evidence” of suspect payments to DCI boss Mohamed Amin on September 1, 2025.

On Wednesday, the DCI said in the course of investigations, some 24 suspects from various medical facilities have been charged.

“So far, 18 case files have been forwarded to the ODPP for review and legal guidance. The ODPP approved the prosecution of nine cases, while five more case files are waiting for review and advice,” said the DCI in a statement.

Further, three case files have been returned to the DCI for further investigations while seven case files are still being investigated before being submitted to the ODPP for review and guidance.

Two weeks after Duale handed over the files, the court granted the DCI permission to probe 31 health facilities, among them Rachuonyo County Hospital, Salama Yard Medical Centre, Nabuala Hospital, Kotiende Medical Centre, Vebeneza Medical Centre-Tassia, The Webuye Hospital Limited, Nyatoto Health Centre, Zion Aradi Mediclinic, Butere, St. Mark Orthodox Hospital- Chavakali and Oasis Doctors Plaza Kakamega Limited.

Others are Tanaja Hospital Limited, Brimaxa Hospital Limited, Maxicare Sunrise Ltd Hospital, Queen Rivers Medical Center, Archprime Medical Clinic Oyugis, Lemayian Hospital-Kitengela, Walalaha Nursing Home, Torics Nursing Home, Nissi Medical Centre, Dawa Front Healthcare Services, New Manyalo Nursing Home, and Jambo Jipya Hospital in Mtwapa.

Also under investigations are Lifecare Hospitals Bungoma Ltd and Rachuonyo East Sub County Hospital, Barwako Medical Centre, ADC Market Nursing Home, Al-Bushra Medical Centre, Ankara Nursing Home, Al-Wadud Nursing Home, Mahat Allah Nursing Home and Korondile Health Center.

The hospitals were suspected to have entered and uploaded information or documents to the SHA information system believed to be false with the aim of claiming for payments for the medical services alleged to have been provided.

It also emerged that certain healthcare facilities did not physically exist or lacked proper infrastructure and premises as required by law.

Further, some claims were based on fictitious or ghost patients with no actual treatment having been rendered.

Before handing over the files to police, SHA conducted a forensic audit of its information systems, establishing fraudulent activities by the targeted healthcare facilities.

The fraudulent claims included admission of patients with identical medical conditions at the same time, admission of the same patients in multiple facilities concurrently, and submission of suspected fictitious and up-coded claims for services.

It was also ascertained that certain hospitals filed claims for Cesarean deliveries (C-section) for all patients who delivered through Spontaneous Vaginal Deliveries (SVDs), and performance of identical medical procedures on the same individuals across different facilities, among other malpractices that amounted to false claims.

“The DCI remains committed to ensuring accountability and safeguarding public resources, with investigations ongoing and all culpable parties set to face the law,” assured DCI.