How a Clinic Owner Used Fake Admissions to Claim Ksh11 Million from SHA

Detectives from the Directorate of Criminal Investigations (DCI) arrested a clinic owner accused of fraudulently claiming more than Ksh11 million from the Social Health Authority (SHA) through irregular medical practices and false billing.

In a statement on Monday, March 9, the agency said the suspect, identified as Mishael Otieno Okumu, appeared in court following investigations linking him to fraudulent activities at a medical facility in Nairobi’s Pipeline area.

According to the DCI, investigations uncovered multiple irregularities tied to the operations of the health facility run by the suspect.

"Investigations established that the suspect is the director of a facility located in the Pipeline area of Nairobi County that was involved in several irregular practices, including suspicious admission patterns, use of expired or unauthorized practitioner credentials, false patient admissions and fraudulent billing, among other illegalities that enabled the submission of the fraudulent claims," the statement read.

Detectives stated that the charges filed against the suspect relate to several criminal offences connected to the alleged fraud.

"The suspect and Salama Yard Medical Center Laboratory and Maternity Services were charged with seven offences, including obtaining registration by false pretence contrary to section 320 of the Penal Code, making a false statement and falsification of documents contrary to section 48 (1) (c) of the SHA Act," the statement added.

The DCI also said the suspect faces additional charges under laws dealing with proceeds of crime and money laundering.

"He was also charged with acquisition of proceeds of crime contrary to section 4 (a), as read with section 16 (1) (b) of the Proceeds of Crime and Anti-Money Laundering Act (POCAMLA), and use of proceeds of crime contrary to section 4 (b), as read with section 16 (1) (b) of POCAMLA," the statement continued.

According to the DCI, during court proceedings, Okumu denied the charges leveled against him to which the court ordered that he be remanded as the case continue.

"Mishael pleaded not guilty and was remanded at Capitol Hill police station pending the issuance of bail and bond terms on 16 March 2026, after the presentation of a probation report," the statement concluded.

This comes days after the Office of the Director of Public Prosecutions (ODPP) secured arrest warrants against 20 individuals and eight medical facilities allegedly linked to a Ksh28 million fraud scheme involving SHA.

In a statement on Tuesday, March 3, the ODPP said the move was part of a broader effort to protect public funds within the health system.

"The Director of Public Prosecutions has intensified the fight against corruption in the health sector after the Milimani Law Courts issued warrants of arrest against 20 individuals and eight medical facilities implicated in the Social Health Authority (SHA) fraud scheme," the statement read.

The ODPP said the arrest warrants were granted after the accused persons ignored court summons despite charges having already been approved by the DPP.

"The warrants were granted following an application by Prosecution Counsel Joyce Olajo after the suspects failed to appear in court to answer to criminal charges approved by the DPP," the statement added.

Prosecutors further informed the court that investigations had uncovered an alleged scheme in which medical facilities were fraudulently registered and false claims were submitted for procedures that were never conducted, resulting in significant financial loss.

"Prosecutors told the court the suspects allegedly orchestrated a scheme to fraudulently register medical facilities and bill for medical procedures that were never performed, leading to a loss of approximately Ksh28 million," the statement further read.

Those facing arrest warrants included Ibrahim Rashid, Ahmed Mohamud Adan, Kamsia Hassan Kala, Hawa Alinoor Malo, Naima Sheikh Ali, Adhihakim Sheikh Ali, Adan Adikhaliq Abdullah, Yussuf Siat Jelle, and Mohammed Kulow Ali.

Others included Hassan Adan Ibrahim, Mohamed Mohamud Sheik, Ali Ahmed Adan, Mohamednoor Ismael Omar, Ismail Omar Mohammed, and Ali Adin Ibrahim.

At the same time, the DPP approved charges against several health facilities believed to have played a role in the alleged fraudulent billing and registration scheme.

"Further, the DPP recommended charges against eight medical facilities: Kaafi Nursing Home, Dimtu Nursing Limited, Mama Nerbeel Nursing Home, Kamsihawa Medical Centre, Adfeel Kids Care Medical Centre Limited, Julun Nursing Home, Danaba Care Hospital Limited, and Alati Nursing Home, for their alleged role in the fraudulent scheme," the statement explained.