The Directorate of Criminal Investigations (DCI) has charged five directors linked to two healthcare facilities over an alleged fraud scheme targeting the Social Health Authority (SHA).
In a statement on Tuesday, July 28, the agency said the five suspects, who are directors of Nissi Medical Centre and Dawa Front Healthcare Services, were arraigned before the Milimani Law Courts following investigations into alleged irregular claims submitted to the national health insurer.
The DCI said the investigations were initiated after SHA reported suspected fraud uncovered during a forensic review of claims submitted by contracted healthcare providers.
"The arrests followed a formal complaint lodged by the SHA after a forensic audit uncovered widespread irregularities in medical claims submitted by several contracted healthcare providers," the statement read.
Investigators also established that some healthcare facilities that had previously been shut down by the Kenya Medical Practitioners and Dentists Council (KMPDC) for failing to meet regulatory requirements allegedly continued providing services while remaining under active SHA contracts.
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"The audit further established that some healthcare facilities previously closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) for non-compliance continued to operate under active SHA contracts," the statement added.
According to the DCI, subsequent investigations found that the suspects allegedly orchestrated fraudulent schemes involving irregular and fictitious medical claims.
These included claims for patients who were never admitted, falsified medical records, and false statements allegedly made to secure payments from SHA.
Detectives also established that some claims were submitted by facilities operating outside the requirements of the Social Health Insurance Act and other applicable regulatory frameworks.
The agency further disclosed that the alleged fraud resulted in millions of shillings being paid out to the two healthcare facilities, while investigators managed to stop additional payments before they were processed.
"Investigations also revealed that Nissi Medical Centre allegedly received more than Ksh38.7 million through fraudulent claims, while Dawa Front Healthcare Services is suspected to have fraudulently obtained more than Ksh2.5 million. Detectives also intercepted additional claims worth over Ksh8.1 million before payment," the statement further read.
According to the DCI, the five accused persons - Nissi Medical Centre directors Dominic Atieno and Peter Atieno, alongside Dawa Front Healthcare Services directors Eugine Ochieng, Enos Osire, and Elija Otieno - were charged with conspiracy to commit a felony, making false statements to obtain benefits under the Social Health Insurance Act, and acquisition and use of proceeds of crime contrary to the Proceeds of Crime and Anti-Money Laundering Act (POCAMLA).
The DCI said investigations are continuing, with detectives pursuing additional suspects believed to have played a role in the alleged SHA fraud scheme.
This comes a day after detectives arrested a procurement officer in connection with a fraud scheme that siphoned off Ksh675,000 from the Mwai Kibaki Hospital in Nyeri County.
In a statement on Monday, July 27, the agency said the suspect, identified as Bernard Mutegi, was apprehended by detectives from the Serious Crimes Unit (SCU).
"A procurement officer has been detained in connection with a fraudulent scheme that siphoned off Sh675,000 from the Mwai Kibaki Hospital Annex, KNH Othaya in Nyeri County.
"The suspect, Bernard Mutegi, was arrested today in Chuka by detectives from the Serious Crimes Unit (SCU) attached at Kenyatta National Hospital (KNH)," read the statement in part.
According to the DCI, the alleged scheme was carried out between June 30, 2022, and November 8, 2023.
The investigative agency noted that Mutegi prepared fake delivery notes and payment vouchers in the name of Fesmat Investments.
The forged documents falsely indicated that aprons had been supplied to the hospital, paving the way for the release of Ksh675,000 for supplies that were never delivered.
"The investigation unearthed that from June 30, 2022, to November 8, 2023, the suspect allegedly concocted a scheme involving fake delivery notes and payment vouchers in the name of Fesmat Investments," DCI stated.
Upon completion of investigations, the case file was submitted to the Office of the Director of Public Prosecutions (ODPP), which approved the prosecution of the suspect.
