Health CS Aden Duale during the ministry’s handover on Tuesday/FILEHealth Cabinet Secretary Aden Duale has constituted a special committee to verify pending medical claims submitted to the defunct National Health Insurance Fund (NHIF) within 90 days.
The NHIF was disbanded as part of President William Ruto’s radical measures aimed at ensuring universal health coverage and replaced by the Social Health Authority (SHA).
Duale had promised to form a task force to audit all the pending bills claimed by health facilities to NHIF.
The CS said the move is aimed at addressing concerns over delayed or questionable reimbursements within the health insurance system.
According to a special issue of the Kenya Gazette dated March 28, 2025, the newly formed committee will be officially named the NHIF Pending Medical Claims Verification Committee.
It will be tasked with scrutinizing outstanding medical claims and providing recommendations on their validity.
The committee will be chaired by James Masiro Ojoo, with Anne Dr Wamae serving as vice-chairperson.
Other members include Edward Kiprono Biwott, Mehsack Mlampe, Yabesh Awele Arwet, Tom Nyakiba, Catherine Karuri Bosire, Paul Waire, Peter Githaiga Mungai, Jacqueline Masha, Dr Judith Anyango and David Owino.
According to the gazette notice, the secretariat will be headed by Peter Kibedu, supported by Susan Mbogoh, Dr Chemutai Ogoyi, Dr Emmanuel Ayodi Ludigi, Hillman Yusuf, and Elibet Kituyi.
The committee has been granted a three-month term to analyze and verify existing pending NHIF claims, recommending settlement or dismissal.
The panel will establish clear criteria for examining claims, identify anomalies or fraud in submitted claims, prepare reports and policy recommendations to relevant government agencies and recommend measures to prevent future claim irregularities.
The team will undertake research and consultations as needed and submit a detailed report to the Ministry of Health with settlement proposals.
“The team is also expected to assess claims-related data from various NHIF-accredited facilities and may consult any stakeholder or expert to fulfil its mandate,’’ reads the Gazette Notice in part.
The CS emphasized
the importance of transparency and accountability in the audit operations and
reiterated that any officer found guilty of misconduct related to claims
processing would be held accountable.
The
committee will be based at the Social Health Authority Building in Nairobi and
will begin its duties effective immediately.
This
development comes amid heightened scrutiny of NHIF’s operations as the
government moves to reform the public health insurance scheme to better serve
Kenyans.
