NAIROBI, Kenya, Aug 13 — The High Court in Eldoret has declared the establishment of the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee illegal.
The court cited multiple constitutional breaches, including violations of patients’ right to privacy under Article 31 of the Constitution.
Delivering judgment in Constitutional Petition No. E011 of 2025, Justice Reuben Nyakundi ruled that the committee — established through Gazette Notice No. 4069 Vol. CXXVII No. 64 of March 28, 2025 — had no constitutional or statutory basis and was “unconstitutional in its entirety.”
“That a declaration [be] and [is] hereby issued that the establishment of the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee through Gazette Notice No. 4069 Vol. CXXVII No. 64 of 28th March 2025 was in contravention of Article 31 of the Constitution of Kenya 2010, as read with the Social Health Authority,” Justice Nyakundi declared in his judgment on Monday.
The court further held that the Cabinet Secretary lacked the constitutional or statutory authority — under both the Constitution and the National Government Coordination Act — to constitute an ad hoc committee of this nature, noting that its creation breached “the letter and spirit of the Constitution.”
Justice Nyakundi observed that the committee’s mandate risked exposing patients’ personal medical data, as the process of “scrutinizing and analysing” claims was only possible by accessing identifiable patient records.
The petitioners, led by Dr. Magare Gikenyi and three others, argued that the committee’s terms of reference duplicated the constitutional mandate of the Auditor-General under Article 229(4)(g) and Section 7 of the Public Audit Act.
They contended that its work usurped the powers of independent oversight offices and contravened the Public Finance Management Act as well as Digital Health Authority regulations.
Patient privacy
The court agreed, noting that even with anonymized data, verifying the “genuineness” of claims would inevitably require access to identifiable medical records — infringing the right to privacy.
Justice Nyakundi ordered the immediate quashing of the committee’s establishment, barred any further reliance on its work, and directed all funds spent on its operations refunded to the Consolidated Fund.
“This was a void decision — invalid from its inception — and from the standpoint of the Constitution, it has no legal effect,” he concluded.
According to the Ministry of Health, the James Mariro-led committee had been tasked with reviewing outstanding medical claims submitted between July 1, 2022, and September 30, 2024.
It was also to develop a framework for assessing the authenticity of each claim, recommend action against fraudulent submissions, and propose reforms to prevent future accumulation of unverified claims.
