NAIROBI, Kenya, Mar 30 – Health Cabinet Secretary Aden Duale has established a committee to scrutinize and verify pending bills owed to hospitals by the now-defunct National Health Insurance Fund (NHIF).
In a special gazette notice, Duale confirmed the formation of the NHIF Pending Medical Claims Verification Committee, which will review outstanding claims accumulated between July 1, 2022, and September 30, 2024.
James Masiro Ojee will chair the committee with Anne Wamae serving as his deputy.
Other members include Edward Kiplimo Bitok, Meshack Matengo, Meboh Atieno Awour, Tom Nyakaba, Catherine Karori Bosire, Paul Wafula, Catherine Mungania, James Oundo, Jackline Mukami Njiru, Judith Awinja, and David Dawe.
They will be supported by a secretariat led by Peter Kitheka, alongside Shawn Mogaka, Dr. Consolata Ogot, Dr. Emmanuel Ayodi Lusigi, Halima Yussuf, and Wilbert Kurgat.
Duale tasked the committee with establishing clear criteria for the detailed examination and analysis of pending medical claims to determine their legitimacy.
Additionally, the committee will recommend necessary actions to the Ministry of Health for the disposal or settlement of verified claims.
Duale emphasized the team will flag any fraudulent or “corrupt medical claims” for further action.
“Identify any cases where there may have been corrupt, fraudulent, or false medical claims and make appropriate recommendations to the relevant government agencies,” he stated in the gazette.
The committee will also propose reforms to prevent future claim backlogs and enhance transparency and efficiency in the claims process.
Claims exceeding Sh10mn
This follows President William Ruto’s pledge to settle NHIF’s outstanding debts, assuring that 91 percent of hospitals contracted by NHIF will receive payments of up to Sh10 million.
In a statement, the president clarified that the remaining 9 percent of hospitals, whose total claims exceed Sh10 million, will undergo verification before payments are released.
The directive comes amid a standoff between the government and private hospitals, which recently rejected the new Social Health Authority (SHA) cover due to unpaid NHIF debts.
As a result, hospitals have begun demanding cash payments from patients, raising concerns about a looming health crisis.
