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Probe shows SHA paid falsified invoices, while in others, money was disbursed to non-existent health facilities.
A 28-year-old woman walked into St Mark Orthodox Health Centre in Vihiga on May 18 for her final prenatal clinic appointment before delivery.
The doctor administered painkillers for a persistent headache. Investigations now show that four days later, she returned to the hospital and delivered a healthy baby boy through a normal birth.
As a registered member of the Social Health Authority (SHA), the State insurer covered her bill. Typically, normal deliveries in public and mission hospitals cost around Sh10,000.
However, a Directorate of Criminal Investigations (DCI) probe indicates that the facility was paid Sh285,000 after falsely claiming to have conducted a Caesarean section and nursed the mother and baby for a week.
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The baby is now five months old, and the mother is a witness in one of the many cases forming part of the Duale dossier — a batch of files submitted by Health Cabinet Secretary Aden Duale to the DCI for investigation into an alleged multibillion-shilling medical billing racket.
Mr Duale has not disclosed the total amount suspected to have been lost through the fraud.
Health Cabinet Secretary Aden Duale addresses the media at the Ministry of Health headquarters in Nairobi, on April 10, 2025.
A DCI officer told the Nation that the team will estimate the total figure once document verification is complete. The officer revealed that the probe team’s in-tray has grown by 700 files, with more than 1,800 health facilities now under investigation.
Widespread billing irregularities
In September, Mr Duale handed 1,188 files to the DCI, exposing widespread billing irregularities replicated across hundreds of facilities.
The probe shows that in some cases, SHA paid falsified invoices, while in others, money was disbursed to non-existent health facilities.
One emerging pattern involves a SHA accountant who authorised payments to multiple hospitals, some of which have since been shut down.
The DCI on Tuesday arrested the accountant, who is said to have approved half of the Sh7 million paid to the Vihiga hospital and millions more to other facilities countrywide.
Nation cannot name the accountant for legal reasons.
Barely 24 hours earlier, two St Mark Orthodox Health Centre employees — Sammy Otieno and Patrick Kanya — denied charges related to the alleged billing fraud before Chief Magistrate Lucy Onyina at the Milimani Law Courts.
They were charged alongside officials of Kilifi’s Jambo Jipya Medical Clinic — director Faith Chepkurui, clinical officers Steven Okinyi and Justine Baraka, nurse Pauline Wanjiru, and receptionist Naida Mbeyu.
Jambo Jipya is accused of falsifying claims amounting to Sh2.02 million.
All the accused denied multiple charges, including conspiracy to commit a felony, forgery, falsification of records, obtaining proceeds of crime, cheating, and uttering false documents. They were released on a Sh600,000 bond each.
Investigations further show that another patient treated at the Vihiga facility and allowed to recover at home was falsely listed as an inpatient, leading to a Sh180,000 payout.
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According to the facility’s claim forms to SHA, the patient had been admitted for 15 days with a minor stomach injury.
However, both investigators and the Health Ministry’s master health facility registry confirm that St Mark Orthodox Health Centre does not offer inpatient services.
The Social Health Authority building in Nairobi.
The facility, which began operations in 2023, has no inpatient beds, according to the ministry’s database, evidence prosecutors will rely on to pursue convictions.
The investigation team comprises officers from the DCI’s Serious Crimes Unit, Economic and Commercial Crimes Unit, and the Banking Fraud Investigation Unit.
An investigator familiar with the findings said some payments were made to non-existent facilities, while others were for services patients paid for privately at different hospitals.
That branch of the billing fraud has been noticed with x-rays, MRI scans and other such tests.
The team, he added, is expected to make several arrests in the coming weeks as they continue to verify some of the documents and information that Health CS Duale handed to the DCI in September.
