Health CS Aden Duale Forms Team to Verify Pending NHIF Claims

• Mar 30, 2025

Health Cabinet Secretary Aden Duale has appointed a 19-member committee to review and verify unpaid medical claims accumulated under the now-defunct National Health Insurance Fund (NHIF). The committee will assess the legitimacy of outstanding claims from July 1, 2022, to September 30, 2024, and recommend payment solutions.

Announcing the decision through a gazette notice, Duale stated that the NHIF Pending Medical Claims Verification Committee will scrutinize unpaid bills owed to hospitals and ensure transparency in the settlement process. The committee is chaired by James Masiro Ojee, with Dr. Anne Wamae as vice-chairperson. 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, Dr. Judith Awinja, and David Dawe.

The secretariat, responsible for research and documentation, will be led by Peter Kitheka, assisted by Shawn Mogaka, Dr. Consolata Ogot, Dr. Emmanuel Ayodi Lusigi, Halima Yussuf, and Wilbert Kurgat.

Mandate of the Committee

The committee’s primary role is to verify the authenticity of pending medical claims and identify fraudulent or false submissions. It will also recommend ways to prevent future accumulation of unpaid bills.

“The team will establish clear criteria to analyze claims and determine their authenticity. Any fraudulent cases will be flagged, with recommendations forwarded to relevant government agencies,” the gazette notice states.

Additionally, the committee will review past reports, conduct research, and suggest reforms to improve health insurance claims processing. It will also propose solutions for settling unpaid claims and enhancing efficiency in the health financing system.

The committee will serve for three months and will be based at the Social Health Authority (SHA) headquarters.

Concerns from Private Hospitals

Private healthcare providers have raised concerns over the government prioritizing Social Health Authority (SHA) claims before settling NHIF arrears.

A report presented to the Departmental Committee on Health of the National Assembly by the Rural and Urban Private Hospitals Association of Kenya (RUPHA) and the Kenya Association of Private Hospitals (KAPH) revealed that 55% of private hospitals prefer NHIF arrears to be cleared first before SHA claims are paid.

The report also showed that:

26% of private hospitals support simultaneous payment of NHIF and SHA claims.

19% believe SHA claims should be prioritized over NHIF arrears.

61% of private facilities prefer NHIF arrears settlement first, compared to 51% of faith-based hospitals and 49% of public facilities.

Challenges in NHIF Claims Settlement

While 56% of healthcare providers have completed NHIF claims reconciliation, lower-tier hospitals (Levels 2 and 3) continue to struggle due to limited access to the NHIF portal and lack of awareness.

Additionally, 52% of unpaid healthcare providers have been asked to resubmit their banking details, signaling inefficiencies in the claims settlement process.

Private hospitals argue that NHIF arrears have severely impacted their operations, forcing many to take commercial loans at high-interest rates to stay afloat. RUPHA and KAPH emphasized that delays in payments have placed significant financial strain on hospitals, especially during the transition from NHIF to SHA.

The SHA system was introduced to improve healthcare access, provider payments, and financing transparency, but private hospitals say its implementation has been slow and problematic.

The associations, representing over 1,000 private healthcare facilities, urged Parliament to push for a predictable and transparent health financing model that ensures hospitals continue providing quality services to Kenyans.

“As Parliament is the House of Records, we will provide evidence to support a more transparent and equitable health financing system,” the report stated.