The government has taken a significant step toward resolving the long-standing issue of unpaid medical claims under the National Health Insurance Fund (NHIF) by appointing a special verification committee.
In a gazette notice dated March 28, 2025, Health Cabinet Secretary Aden Duale announced the formation of the National Health Insurance Fund Pending Medical Claims Verification Committee.
The committee, chaired by James Masiro Ojee, has been given a three-month mandate to scrutinise and verify medical claims that have remained unpaid between July 1, 2022, and September 30, 2024.
For years, NHIF has struggled with a growing backlog of unsettled claims, leading to frustration among hospitals and healthcare providers.
Many facilities have repeatedly complained about delayed reimbursements, which have hampered their ability to deliver quality services.
The accumulation of pending payments has not only strained hospital operations but also raised concerns about inefficiencies and possible fraudulent activities within NHIF.
Recognising the urgency of the situation, President William Ruto recently intervened by ordering a comprehensive audit of NHIF’s financial status.
The President directed that before any payments above Sh10 million could be made, there needed to be a thorough verification of claims to weed out fraudulent submissions.
The establishment of the verification committee is a direct outcome of this directive, signaling the government’s commitment to restoring credibility and efficiency in the health insurance system.
The committee has been assigned several critical responsibilities. One of its primary tasks is to review all pending medical claims and determine their legitimacy before making recommendations on their settlement.
It will also be responsible for identifying fraudulent or exaggerated claims and referring any suspected cases of corruption to the relevant government agencies.
Additionally, the committee is expected to propose long-term reforms that will prevent a similar backlog from occurring in the future.
By analysing NHIF’s claims management process, the committee will advise the Ministry of Health on the best approaches to ensure transparency and efficiency in payment processing.
With a strict three-month timeline, the committee will have to work swiftly to complete its mandate.
It has been granted access to all necessary reports and will be based at the Social Health Authority building.
The findings of this verification process will be crucial in determining whether hospitals receive their long-overdue payments or if further investigations and legal actions will be required.
This initiative comes at a time when the government is rolling out a new social health insurance system, and the success of the verification committee could set the foundation for broader NHIF reforms.
If executed effectively, it could not only help clear the existing backlog but also restore confidence in Kenya’s national health insurance scheme.
