Government forms 19-member committee to address unsettled NHIF claims
Government forms 19-member committee to address unsettled NHIF claims
Health Cabinet Secretary Aden Duale has announced the format of the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee to address the backlog of unsettled medical claims.
In a statement on Saturday, March 29, Duale said the committee will be chaired by James Masiro Ojee, alongside Vice-Chairperson Dr. Anne Wamae and consists of 17 members.
According to the CS, their primary task is to scrutinize all pending claims accumulated between July 1, 2022, and September 30, 2024.
The committee will also evaluate the legitimacy of the claims, ensuring that genuine submissions are settled while fraudulent or irregular ones are flagged for appropriate action.
“The Government has constituted the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee to address the backlog of unsettled medical claims.
“It will make recommendations on the settlement of genuine claims while identifying and flagging any fraudulent or irregular submissions for appropriate action,” he said.
Beyond resolving existing cases, the committee has also been tasked with proposing long-term reforms aimed at preventing future claim backlogs.
“Additionally, the committee will propose long-term reforms to prevent future claim backlogs, ensuring a transparent, accountable, and efficient claims process,” the CS added.
The members of the committee 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 will be led by Peter Kitheka, with Shawn Mogaka, Dr. Consolata Ogot, Dr. Emmanuel Ayodi Lusigi, Halima Yussuf and Wilbert Kurgat assisting in its operations.
This development comes barely a month after President William Ruto promised to have a verification committee set up to address pending NHIF claims.
In a statement on Wednesday, March 5, Ruto announced a plan to clear the outstanding debt, acknowledging the financial strain caused by NHIF’s debts on health facilities.
“National Health Insurance Fund (NHIF) debts have been a heavy burden on healthcare facilities and providers for the past 10 years. This has had a devastating effect in the provision of health services in public, faith-based and private hospitals.
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“By the time the NHIF was wound up in November 22 2024, it had a whopping debt of Ksh33 billion, affecting the ability of health facilities to provide services under the Social Health Authority (SHA),” the statement read.
To address the debt crisis, Ruto said the government will immediately make full payments to hospitals with claims of Ksh10 million and below.
1He added that hospitals with claims exceeding Ksh10 million will undergo a verification process to be completed within 90 days before a structured payment plan is implemented.
“The government has resolved to pay all hospitals with total claims of Ksh10 million and below in full, representing 91 per cent of all facilities that were contracted by NHIF.
“The remaining 9 percent of hospitals, with total claims of above Ksh10 million, will be subjected to a verification exercise that should be completed within 90 days after which a payment plan will be agreed on,” the statement added.
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