30 health facilities to be prosecuted over SHA fraud

The Directorate of Criminal Investigations (DCI) says investigations into the fraud complaints and a forensic audit into the transaction by the facilities show that they all have a case to answer.

Already, 18 facilities and 50 individuals are before the court over fraud charges. 

The latest report released by the DCI boss, dated April 2, gives a breakdown of the status of 260 fraud complaints lodged by SHA.

The report shows that out of the 260 cases, 30 case files have already been submitted to the office of the Director of Public Prosecution for approval.

A total of 68 suspects and facilities have been charged with their cases pending in court, charges against 19 others have been approved by the DPP, while suspects have obtained conservatory orders or sought alternative dispute resolution and refunded overpayments to the SHA.

Among those whose cases are pending in court are the former NHIF Chief Executive Officer, who later held the same position at the Social Health Authority, Elijah Wachira, and former acting SHA CEO Robert Ingasira.

They are among 50 individuals who have been charged over fraudulent claims at the Social Health Authority.

The two were charged alongside two directors of Archprime Medical Clinic over falsification of medical records and the use of proceeds of crime amounting to 17.5 million.

An ICT officer at the Kenya Medical Practitioners and Dentists’ Council is also among those charged. Harun Liluma has been charged with the fraudulent registration of eight different facilities and receiving unlawful payments from the Social Health Authority.

According to the DCI, the KMPDC officer, together with 15 directors from the eight facilities, unlawfully received 30.7 million from SHA.

The facilities are: Danaba Care Hospital, Kamsihawa Medical Centre, Kaafi Nursing Home, Mama Nerbeel Nursing Home, Alati Nursing Home, Julun Nursing Home, Adfaal Kids Care Medical Centre, and Dimtu Nursing Home Limited—all from Mandera County and are among the 19 facilities that have received approval from the ODPP for prosecution.

The DCI report shows Mandera as one of the leading counties with fraudulent claims, with 51 facilities flagged and suspended.

The facilities are accused of falsification of documents, conversion of outpatient cases into inpatient claims, forgery of documents to demand extra payments, payments made to medical facilities without signed contracts with the Social Health Authority, claims submitted by non-existent medical facilities, and payments to facilities operating using fraudulently acquired KMPDC licenses.

Health Cabinet Secretary Aden Duale maintains that no public funds have been lost under SHA, adding that the authority has rejected over Ksh.12.7 billion in fraudulent claims.

"The SHA is anchored under a very robust technology digital system that detects patients, doctors, facilities, the whole spectrum of the healthcare system in our country, and we have reduced fraud from over 36% when I became the minister to about 6%,” said Health Cabinet Secretary Aden Duale.

The CS warned facilities, healthcare workers, and patients that the government will take all necessary action to ensure the success of Universal Health Coverage.