SHA fraud probe: Evidence submitted to DCI as 85 health facilities suspended

In a statement on Monday, CS Duale stated that a rigorous forensic audit has uncovered troubling patterns of fraud that directly affect the public.

Some of the practices include submitting altered medical reports, illegally converting billing of outpatient to inpatient visits, submitting claims for ghost patients and upcoding — billing for costlier procedures than services provided.

Similarly, the Kenya Medical Practitioners and Dentists Council (KMPDC) has conducted inspections which have resulted in the closure of 544 unlicensed health facilities.

Other 454 health facilities had their operating licenses revoked due to a range of violations, including operating below required standards, employing unlicensed practitioners, and lacking critical infrastructure, posing a direct threat to patient health.

Duale has added that KMPDU and SHA have now submitted 1,188 files and supporting evidence to the Directorate of Criminal Investigations (DCI) to conduct further probe.

SHA has provided 190 files and KMPDC has submitted 998 files.

CS Duale further warned that any facility, doctor, or patient involved in fraud will be brought to book.

SHA Chief Executive Officer Mercy Mwangangi had earlier announced that the affected hospitals shall not be entitled to any SHA benefits during the period of suspension.