Five Directors Arraigned Over Alleged Sh41 Million SHA Fraud

Five directors linked to two healthcare providers have been arraigned at the Milimani Law Courts over an alleged scheme to defraud the Social Health Authority (SHA) of more than Sh41 million through fictitious medical claims.

In a statement, the Directorate of Criminal Investigations (DCI) said the suspects are directors of Nissi Medical Centre and Dawa Front Healthcare Services, which are under investigation following a complaint lodged by SHA.

The probe was triggered after a forensic audit uncovered widespread irregularities in medical claims submitted by several healthcare facilities contracted by the authority

According to the DCI, investigators also established that some health facilities previously closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) for non-compliance continued operating under active SHA contracts.

Detectives allege that the suspects orchestrated a fraudulent scheme involving fake medical claims, including claims for patients who were never admitted, falsified medical records and false declarations made to obtain payments from SHA.

Investigations further found that some claims were submitted by facilities operating outside the provisions of the Social Health Insurance Act and other regulatory requirements.

The DCI said Nissi Medical Centre allegedly received more than Sh38.7 million through fraudulent claims, while Dawa Front Healthcare Services is suspected to have fraudulently obtained more than Sh2.5 million.

Detectives also intercepted additional claims worth over Sh8.1 million before the payments could be processed.

The accused are Dominic Atieno and Peter Atieno, directors of Nissi Medical Centre, and Eugine Ochieng, Enos Osire and Elija Otieno, directors of Dawa Front Healthcare Services.

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).

The DCI said investigations are ongoing, with detectives pursuing additional suspects believed to be linked to the alleged fraud network.

The agency said it remains committed to protecting public resources and ensuring individuals who exploit public health financing systems through fraud are held accountable.