More than 8,500 hospitals previously contracted under the now-defunct National Health Insurance Fund (NHIF) are expected to learn the fate of over Sh33 billion in unpaid claims within the next three months, following the commencement of a sweeping verification exercise by a newly formed committee.
The NHIF pending medical verification committee, chaired by James Masiero Ojee and deputised by Anne Wamai, has been tasked with reviewing and authenticating all outstanding medical claims, including the Sh22 billion owed to members of the Rural Private Hospitals Association of Kenya (RUPHA).
The review targets claims accumulated over a two-year period and is scheduled to conclude within 90 days.
Health Cabinet Secretary Aden Duale, announcing the committee’s mandate, underscored the importance of accuracy, integrity, and financial accountability in the process.
"I would like to urge and request the committee to thoroughly scrutinise the outstanding claims and recommend payment of only those that are genuine," Duale stated.
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"While the government understands the financial difficulties faced by some healthcare providers, it is crucial that this process ensures value for money, transparency, and accountability in the purchase of healthcare services."
The 14-member committee includes Edward Kiplimo Bitok, Meshack Matengo, Meboh Atieno Awour, Tom Nyakaba, Catherine Karori Bosire, Paul Wafula, Catherine Mungania, James Oundo, Jackline Mukami Njiru, Judith Awinja, and David Dawe, alongside the chair and vice-chair.
Their responsibilities are wide-ranging: they must verify the legitimacy of pending claims, develop a consistent framework for claim assessment, detect and flag fraudulent or exaggerated claims, and forward suspected cases of malpractice or corruption to the relevant enforcement agencies.
Furthermore, they will advise on payment for confirmed claims and propose systemic reforms to deter future claim inflation.
"Let me emphasise that all genuine claims by healthcare providers will be paid after verification. This committee will be held accountable for any payments made for services not rendered," Duale reiterated.
The committee's formation was formalised through Kenya Gazette Notice No. 4069 on 28 March 2025 in response to President William Ruto’s directive to hasten the settlement of validated NHIF claims.
According to the presidential order, facilities with claims of Sh10 million or less—accounting for 91 per cent of the affected hospitals—are slated to receive full payment without delay.
The remaining nine per cent, comprising facilities with claims above Sh10 million, will undergo the full scrutiny of the 90-day verification process.
