The Ministry of Health has constituted a new committee to verify and resolve pending National Health Insurance Fund (NHIF) medical claims dating from July 1, 2022, to September 30, 2024. This comes amid increasing concerns over delayed payments and possible fraudulent claims within the health sector.
In a special issue of the Kenya Gazette, the Cabinet Secretary for Health, Aden Duale, announced the formation of the NHIF Pending Medical Claims Verification Committee, tasked with analyzing and resolving the backlog of claims.
The committee will be chaired by James Masiso Ojee, with Dr. Anne Wamae serving as vice-chairperson. It includes 13 members drawn from various sectors, with Peter Kitheka appointed as Head of Secretariat.
The core objective of the committee is to “scrutinize and analyze the existing NHIF pending medical claims that have accumulated… and make recommendations to the Ministry of Health on settlement,” as outlined in the Gazette.
Other key roles of the committee include establishing criteria for evaluating claims, identifying fraudulent submissions, and recommending accountability measures. It will also propose reforms to enhance future claims processing and report its findings to the Ministry.
The committee is empowered to access past reports, call for documents, co-opt experts, and liaise with government bodies. Members are expected to serve for three months from the date of notice issuance.
The Gazette notice states:
”The Committee shall… make recommendations to the Ministry of Health on the necessary actions to be taken for satisfactory disposal or settlement of the identified pending medical claims.”
This move is expected to improve transparency and streamline NHIF operations. The committee will operate from the Social Health Authority building.
