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Health Cabinet Secretary Aden Duale has set up a special committee to review unresolved medical claims submitted to the now-defunct National Health Insurance Fund (NHIF) within a 90-day timeframe.
The NHIF was recently dissolved as part of President William Ruto’s broader reforms to achieve universal health coverage, with the Social Health Authority (SHA) taking its place.
Duale had earlier pledged to form a task force to assess outstanding payments requested by healthcare providers through the NHIF.
The CS stated that the initiative aims to resolve concerns about delayed or potentially irregular reimbursements within the system.
As per a Kenya Gazette notice dated March 28, 2025, the new body will be known as the NHIF Pending Medical Claims Verification Committee.
The committee’s mandate is to evaluate pending medical claims and issue recommendations regarding their legitimacy.
James Masiro Ojoo will serve as the chairperson, while Anne Dr Wamae will be the vice-chair. 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.
The secretariat will be led by Peter Kibedu, with assistance from Susan Mbogoh, Dr Chemutai Ogoyi, Dr Emmanuel Ayodi Ludigi, Hillman Yusuf, and Elibet Kituyi.
The committee will operate for three months, during which it will verify the validity of claims and advise on their settlement or rejection.
Its responsibilities include creating standards for claim assessment, detecting fraud or inconsistencies, compiling reports and policy suggestions for relevant authorities, and proposing measures to avoid future irregularities.
Additionally, the panel will conduct research, consult stakeholders or experts, and present a comprehensive report to the Ministry of Health outlining recommendations for resolving outstanding claims.
“The team will also analyze claims data from NHIF-accredited institutions and may consult stakeholders to fully carry out its duties,” the gazette notice states.
Duale highlighted the importance of transparency and accountability throughout the process and warned that any officials found to have engaged in malpractice related to claims would face consequences.
The committee, which will operate from the Social Health Authority Building in Nairobi, is set to begin work immediately.
This initiative follows increasing scrutiny of the NHIF as the government seeks to overhaul the public health insurance system to improve service delivery for Kenyans.
