Kilifi Clinic Officials Face Fraud Charges in Nairobi

Six officials from Jambo Jipya Medical Clinic in Kilifi County were on Monday, October 6, 2025, charged in Nairobi with defrauding the Social Health Authority (SHA) of more than KSh 2 million. The accused, identified as Patrick Kimuyu Kanya, Faith Chepkurui Bii, Steven Okinyi Ojwano, Justine Baraka, Pauline Wanjiru, and Naida Mbeyu, appeared before Chief Magistrate Lucas Onyina at the Milimani Law Courts. They face multiple charges, including conspiracy to commit a felony, falsification of information, acquisition and use of proceeds of crime, cheating, and forgery.

Prosecutors allege that the officials manipulated patient details and medical records to create false impressions of treatment, enabling them to fraudulently obtain payments from the SHA. The Office of the Director of Public Prosecutions (ODPP) confirmed that the charges followed a detailed inquiry file submitted by the Directorate of Criminal Investigations (DCI) on October 1, 2025.

Context of Kenya's Healthcare Reforms and SHA

This case emerges amidst a broader government crackdown on healthcare fraud, particularly targeting the newly established Social Health Authority (SHA). The SHA, a state corporation, was formed under the Social Health Insurance Act, 2023, to replace the National Hospital Insurance Fund (NHIF) and aims to provide universal health coverage to all Kenyans. The Social Health Insurance Act, along with the Primary Health Care Act, Facility Improvement Financing Act, and Digital Health Act, were signed into law in October 2023 to strengthen Kenya's healthcare system.

The SHA officially began its operations on October 1, 2024, with a mandate to administer the Social Health Insurance Fund (SHIF), Primary Healthcare Fund, and Emergency, Chronic and Critical Illness Fund. Under the SHIF, employed Kenyans are expected to contribute 2.75% of their gross salary, with a minimum contribution of KSh 300 per month.

Allegations and Legal Proceedings

According to the charge sheet, the alleged fraudulent activities at Jambo Jipya Medical Clinic occurred between November 1, 2024, and June 30, 2025, leading to the SHA disbursing KSh 2,032,680. Specific allegations include Kanya and Bii falsely claiming KSh 30,000 for a Caesarean section for a patient who delivered normally. Ojwang and Baraka are accused of forging clinical notes, while Wanjiru allegedly falsified an inpatient file entry.

Defence lawyer Ndegwa Njiru challenged the court's jurisdiction, arguing that disputes between the SHA and service providers should be handled by a Ministry of Health tribunal, citing Section 44 of the SHA Act. However, the prosecution, represented by Norah Awiti, countered that Article 157 of the Constitution empowers the DPP to initiate criminal proceedings regardless of tribunal involvement. Chief Magistrate Onyina sided with the DPP, affirming the court's authority.

All six accused denied the charges and were released on bond. Kanya and Bii were granted a bond of KSh 600,000 or a cash bail of KSh 200,000 each, while Ojwang, Baraka, Wanjiru, and Mbeyu received a KSh 200,000 bond or KSh 70,000 cash bail each.

Broader Implications and Ongoing Investigations

This case is part of a larger investigation into widespread fraud within the SHA. The DCI announced on Friday, October 3, 2025, that it had arrested five suspects in connection with fraud allegations at the SHA, following scrutiny of 1,188 files received from the SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC) on September 1, 2025. Official Ministry of Health data suggests that between 28% and 35% of medical claims in Kenya may be fraudulent.

The Financial Reporting Centre (FRC) has also flagged questionable payments totaling KSh 558.6 million to 45 hospitals suspected of being conduits for siphoning public funds from the Social Health Insurance Fund and Primary Health Care Fund between October 2024 and July 2025. In August 2025, the SHA suspended 40 facilities over fraudulent claims, with Health Cabinet Secretary Aden Duale warning that providers involved in fraud would be held personally liable.

What to Watch

The case involving the Kilifi clinic officials is scheduled for mention on Tuesday, October 21, 2025, for pre-trial directions. Further arrests are anticipated as DCI investigations continue, with approvals from the ODPP. The outcome of these cases will be crucial in shaping public confidence in the SHA and the government's commitment to ensuring equitable and affordable healthcare for all Kenyans.

Evidence/Data Box

• Accused: Six officials from Jambo Jipya Medical Clinic, Kilifi County.
• Alleged Fraud Amount: Over KSh 2 million.
• Period of Alleged Offences: November 1, 2024, to June 30, 2025.
• Charges: Conspiracy to commit a felony, falsification of information, acquisition and use of proceeds of crime, cheating, and forgery.
• SHA Launch Date: October 1, 2024.
• Estimated Fraudulent Claims in Kenya: 28-35% of medical claims (Ministry of Health).
• Total Questionable Payments Flagged by FRC: KSh 558.6 million to 45 hospitals (October 2024 - July 2025).