The Kenya Medical Practitioners and Dentists Council (KMPDC) and the Social Health Authority (SHA) have handed over more than one thousand files to the Directorate of Criminal Investigations (DCI) for investigations.
In a statement on Monday, September 1, Health Cabinet Secretary Aden Duale confirmed the move as part of efforts to crack down on fraudulent and non-compliant health facilities across the country.
"The Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC) has today submitted a total of 1188 files and supporting evidence to the Directorate of Criminal Investigations (DCI) - a major step in their joint fight against healthcare fraud.
"This action targets fraudulent and non-compliant healthcare facilities and individuals, marking a critical milestone in the ongoing effort to protect public funds and safeguard the integrity of Kenya's healthcare system," the statement read.
According to KMPDC, of the 1,188 files submitted, SHA provided 190 while KMPDC delivered 998.
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The SHA files were categorized into three groups; 24 facilities where evidence of fraud has already been concluded, 61 facilities still under investigation, and 105 facilities that had been closed by KMPDC but still held contracts with the Authority.
KMPDC’s files focus facilities accused of operating outside the law.
"These submissions are a critical step in a multi-agency collaboration that will see the DCI investigate and prosecute those responsible," the statement added.
According to KMPDC, the schemes under investigation include inflating medical bills by converting outpatient visits into inpatient admissions, falsifying records, billing for procedures never carried out, and submitting claims for nonexistent patients.
"SHA, in line with its mandate, has suspended a total of Eighty-Five (85) health facilities for fraudulent activities to allow for investigations. The rigorous forensic audits and digital system have uncovered deeply troubling patterns of fraud that directly harm the public and deplete the monies meant for patients.
"KMPDC, for its part, and in line with its mandate, has conducted extensive inspections, which recently resulted in the closure of 544 Health Facilities for being unregistered or unlicensed and revocation of operating licenses of 454 health facilities 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," the statement further read.
KMPDC further noted that SHA has also taken disciplinary measures against individual practitioners linked to fraudulent schemes.
"SHA has already withdrawn user rights for 12 healthcare professionals implicated in criminal schemes and will be surcharging facilities to recover any monies paid based on fraudulent claims. We have a duty to pay only for services legitimately rendered and to hold those who seek to defraud the system accountable," the statement concluded.
Notably, this comes days after KMPDC closed down 158 health facilities in Nairobi over non-compliance.
In a statement on Thursday, August 28, KMPDC CEO David Kariuki said the council, in collaboration with other health regulatory bodies, conducted an inspection covering 288 health facilities in Nairobi.
The inspection led to the downgrading of 25 facilities, while 105 were maintained at their current level.
Kariuki noted that most of the facilities shut down or downgraded were either unregistered, unlicensed, employing unqualified practitioners, or operating below the required standards.
"Others lacked critical infrastructure such as pharmacies, maternity wings, and laboratories. Others faced sanitation issues, inadequate waste disposal, posing a direct threat to patient health," the statement read in part.
