Director of Public Prosecutions Renson Ingonga has approved charges against 10 suspects among them four directors of health facilities, over the multi-million Social Health Authority (SHA) fraud.
The individuals are suspected to have colluded to defraud SHA, through various fraudulent practices, including billing for more expensive procedures than performed, falsifying patient records, converting outpatient visits into inpatient claims, and submitting claims for non-existent patients.
"After a thorough review of inquiry files submitted on October 1, 2025 by the Directorate of Criminal Investigations, the Director of Public Prosecutions has directed that the persons involved be charged with fraud and other charges including those in the Proceeds of Crime and Anti-Money Laundering Act, the Social Health Insurance Act, and the Anti-Corruption and Economic Crimes Act," reads a statement by DPP Ingonga.
The approval now gives investigators a green light to charge the individuals over the alleged involvement in healthcare fraud linked to files submitted by the Social Health Authority (SHA) and the Kenya Medical Practitioners and Dentists Council (KMPDC).
The suspects in the multi-million fraud include; a Social Health Authority (SHA) employee, four directors of private health facilities in Kilifi and Vihiga Counties and several employees.
The directors and employees of the two facilities; Jambo Jipya Medical Clinic in Kilifi County and St Mark Orthodox Hospital in Vihiga County are said to have colluded with the SHA employee to undermine government efforts to deliver quality healthcare to Kenyans.
Two directors and five employees of Jambo Jipya Medical Clinic in Kilifi County, which submitted Sh2 million worth of fraudulent claims face several charges including conspiracy to commit a felony contrary to Section 393 of the Penal Code.
The suspects include; Mr Patrick Kimuyu and Ms Faith Chepkururi Bii both directors of Jambo Jipya Medical Clinic and employees Steven Ojwang,Justine Baraka,Maina Macharia,Pauline Wanjiru and Nadia Mbeyu.
The suspects further face charges of forgery, fraudulent alteration of information contrary to Section 48(5) of the Social Health Insurance Act, acquisition of proceeds of crime contrary to Section 4(a) as read with Section 16(I) of the Proceeds of Crime and Anti-Money Laundering Act and cheating contrary to Section 315 of the Penal Code.
Also facing fraud charges are two directors of St Mark Orthodox Hospital in Vihiga County; DeSouza Fenley and Mark Dhilion Sydon and Sammy Otieno, an employee of SHA.
Falsification of health documents
St Mark Orthodox Hospital submitted a claim of Sh4.9million and was paid the amount by SHA instead of the correct claim of Sh18,000.
"The two directors of St Mark Orthodox Hospital face charges of cheating contrary to Section 315 of the Penal Code, conspiracy to defraud, acquisition of proceeds of crime contrary to Section 4(a) and Section 16(1) of the Proceeds of Crime and Anti-Money Laundering Act as we as falsification of health documents contrary to the law," reads the statement.
The SHA employee Sammy Otieno faces charges of conspiracy to defraud and conspiracy to commit a felony.
On Friday, a month after the Ministry of Health submitted 1,188 files suspected fraud files to the DCI, detectives made a breakthrough, arresting five of the ten individuals in connection with the multi-million healthcare fraud.
The five Kenyans will be arraigned in court on Monday, October 6, 2025, over alleged fraudulent hospital claims at the Social Health Authority (SHA), as more suspects are being pursued.
The DCI announced the development on Friday, noting that the suspects were identified after an extensive review of files submitted by Health Cabinet Secretary Aden Duale.
"We wish to inform the general public that the 1,188 files are at various stages of investigations. Currently, five suspects are in custody pending arraignment on Monday, October 6, 2025. Efforts to apprehend additional suspects are already underway, following approval from the ODPP," the DCI stated.
The files were handed over by SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC) on September 1, followed public complaints about suspected ongoing fraud in the health sector.
They cover individuals and organisations accused of undermining government efforts to deliver quality healthcare.
"Thorough and expedient investigations were immediately initiated upon receipt of the files. A multi-agency team, led by the DCI, was formed to conduct a comprehensive review of the materials. The aim is to ensure that all individuals involved in any form of healthcare fraud are held accountable for their actions," the DCI said in a statement.
CS Duale had categorised the SHA files into three groups: Category 1 included 24 facilities with confirmed fraud; Category 2 involved 61 facilities under investigation; and Category 3 comprised 105 cases previously closed by KMPDC but still holding contracts with SHA.
Meanwhile, the 998 files from KMPDC covered facilities operating outside legal requirements.
Following the receipt of the files, the DCI set up a multi-agency team tasked with tracing assets and resources acquired through fraudulent activities, ensuring that all those responsible face legal consequences.
