Health Cabinet Secretary Aden Duale has appointed the NHIF Pending Medical Claims Verification Committee to address the backlog of pending claims owed to health facilities. This marks a crucial step toward settling outstanding bills under the now-defunct National Health Insurance Fund (NHIF).
The committee’s primary role will be to scrutinize and verify all NHIF claims accumulated between July 1, 2022, and September 30, 2024. It is tasked with ensuring that claims are accurately assessed and processed while identifying any fraudulent or corrupt activities within the system.
The committee will be chaired by James Masiro Ojee, with Anne Wamae serving as vice chairperson. Other members include 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. The committee will be supported by a secretariat led by Peter Kitheka and additional staff, including Shawn Mogaka, Consolata Ogot, Emmanuel Ayodi Lusigi, Halima Yussuf, and Wilbert Kurgat.
The team will operate under a defined set of terms of reference, which include scrutinizing the pending claims, establishing criteria for their validity, and making recommendations for settlement. Additionally, the committee is expected to identify fraudulent claims and propose reforms to prevent future accumulations of unpaid medical bills.
To facilitate its duties, the committee has been empowered to conduct necessary research, seek expert assistance when needed, and review previous reports relevant to its mandate. It will also regulate its own procedures to ensure a smooth verification process.
The committee will be based at the Social Health Authority (SHA) building in Upper Hill, Nairobi, and will serve for a period of three months starting from the date of the Gazette notice, March 28, 2025.
The formation of this committee comes at a crucial time, as healthcare providers and patients have raised concerns over the slow resolution of pending NHIF claims. The government’s intervention is expected to restore confidence in the health insurance system and improve service delivery in healthcare facilities.
