Five directors of Nissi Medical Centre and Dawa Front Healthcare Services were on Tuesday arraigned in court over their alleged involvement in a fraud scheme targeting the Social Health Authority (SHA).
The five were charged following investigations launched after SHA lodged a formal complaint over suspected irregularities in medical claims submitted by several contracted healthcare providers.
According to the DCI, a forensic audit conducted by the Authority uncovered widespread anomalies in claims processing, with some healthcare facilities that had been closed by the Kenya Medical Practitioners and Dentists Council (KMPDC) for non-compliance allegedly continuing to operate under active SHA contracts.
Investigators established that the suspects allegedly orchestrated fraudulent schemes involving fictitious medical claims, including claims for patients who were never admitted, falsified medical records and false statements made to secure payments from SHA.
Detectives further found that some claims were submitted by facilities operating outside the provisions of the Social Health Insurance Act and other applicable regulatory requirements.
The DCI said investigations revealed that Nissi Medical Centre allegedly received more than Ksh38.7 million through fraudulent claims, while Dawa Front Healthcare Services is suspected to have fraudulently obtained over Ksh2.5 million. Detectives also intercepted additional claims worth more than Ksh8.1 million before they could be paid out.
The accused persons include Nissi Medical Centre directors Dominic Atieno and Peter Atieno, alongside Dawa Front Healthcare Services directors Eugine Ochieng, Enos Osire and Elija Otieno.
They face charges of 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, efforts are underway to trace and apprehend additional suspects believed to be linked to the alleged fraud scheme as investigations continue.
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