The Directorate of Criminal Investigations (DCI) has arraigned five directors of Nissi Medical Centre and Dawa Front Healthcare Services at the Milimani Law Courts over their alleged involvement in a fraud scheme targeting the Social Health Authority (SHA).
The suspects were charged following investigations launched after the SHA lodged a formal complaint over suspicious medical claims submitted by contracted healthcare providers.
According to the DCI, a forensic audit commissioned by the authority uncovered widespread irregularities in claims processing, prompting investigators to examine the operations of several health facilities.
The audit also revealed that some facilities previously closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) for failing to meet regulatory standards continued operating under active SHA contracts.
Investigators allege that the suspects orchestrated fraudulent schemes involving fictitious medical claims, including claims for patients who were never admitted, falsified medical records, and false statements intended to obtain payments from the public health insurer.
Detectives further established that some claims were submitted by facilities operating outside the requirements of the Social Health Insurance Act and other applicable regulatory frameworks.
According to the DCI, 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. Investigators said they also intercepted additional claims worth more than Sh8.1 million before any payments were made.
The five accused are Dominic Atieno and Peter Atieno, directors of Nissi Medical Centre, alongside 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).
Meanwhile, the DCI said investigations are ongoing, with detectives pursuing additional suspects believed to be linked to the alleged fraud network.
The agency reaffirmed its commitment to safeguarding public resources, saying it will continue working to ensure those accused of exploiting public health financing systems through fraud are held accountable in accordance with the law.
