The Directorate of Criminal Investigations (DCI) recently charged five directors of Nissi Medical Centre and Dawa Front Healthcare Services before the Milimani Law Courts over an alleged fraud scheme targeting the Social Health Authority (SHA).
The arrests followed a formal complaint by SHA after a forensic audit uncovered widespread irregularities in medical claims submitted by contracted healthcare providers.
The audit also revealed that some facilities previously closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) for non-compliance continued operating under active SHA contracts.
Suspects in SHA fraud case. Photo: Courtesy.
Investigations established that the suspects orchestrated fraudulent schemes involving irregular and fictitious claims.
These included billing for patients who were never admitted, falsified medical records, and false statements made to obtain payments from SHA.
Some claims were allegedly submitted by facilities operating outside the requirements of the Social Health Insurance Act and other regulatory frameworks.
According to detectives, Nissi Medical Centre allegedly received over Sh38.7 million through fraudulent claims, while Dawa Front Healthcare Services is suspected to have obtained more than Sh2.5 million illegally.
Detectives also intercepted additional claims worth over Sh8.1 million before payment.
The five accused include two Nissi directors, Dominic Atieno and Peter Atieno, and three Dawa Front directors, Eugine Ochieng, Enos Osire, and Elija Otieno.
They face charges including 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).
Meanwhile, detectives are pursuing additional suspects believed to be linked to the alleged fraud scheme as investigations continue.
