Five directors of Nissi Medical Centre and Dawa Front Healthcare Services have been arraigned before the Milimani Law Courts over Ksh 41 million fraud targeting the Social Health Authority (SHA).
The arrests followed a formal complaint lodged by SHA after a forensic audit uncovered widespread irregularities in medical claims submitted by several contracted healthcare providers.
The audit further established that some healthcare facilities previously closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) for non-compliance continued operating under active SHA contracts.
Subsequent investigations revealed that the suspects orchestrated fraudulent schemes involving fictitious medical claims, including claims for patients who were never admitted, falsified medical records, and false statements used to obtain 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.
According to the Directorate of Criminal Investigations (DCI), Nissi Medical Centre received more than Ksh 38.7 million through fraudulent claims, while Dawa Front Healthcare Services is suspected of fraudulently obtaining more than Ksh 2.5 million.
Detectives further intercepted additional fraudulent claims worth more than Ksh 8.1 million before they could be paid.
The five accused are Nissi Medical Centre directors Dominic Atieno and Peter Atieno, and Dawa Front Healthcare Services 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 fraud scheme.
