Over 8,500 hospitals contracted by the defunct National Health Insurance Fund (NHIF) will know the status of their outstanding NHIF medical claims within the next three months, as the NHIF pending medical verification committee begins a critical process of validating over Sh30 billion still owed to these facilities.
The review, which will be completed in 90 days, aims to determine the legitimacy of outstanding claims totalling over Sh33 billion that have accumulated over the past two years, including a significant amount owed to the Rural Private Hospitals Association of Kenya (Rupha), which is facing Sh22 billion in outstanding dues.
Health Cabinet Secretary Aden Duale said the initiative is part of a broader strategy to promote accountability in health financing and ensure that public funds are used efficiently.
"I would like to urge and request the committee to thoroughly scrutinise the outstanding claims and recommend payment of only those that are genuine. 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," said Mr Duale.
The committee, chaired by James Masiero Ojee and assisted by Anne Wamai, will be responsible for conducting a comprehensive and transparent review of the outstanding claims.
Members of the committee are 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's mandate includes reviewing and verifying the authenticity of all pending medical claims, establishing a standardised framework for assessing and analysing claims, identifying and recommending action against fraudulent, false, or exaggerated claims, and referring cases of suspected corruption or malpractice to the appropriate authorities.
In addition, the committee will make recommendations on the settlement of validated claims and propose long-term reforms to prevent the recurrence of unverified or inflated claims.
"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," CS Duale affirmed.
The committee was officially gazetted on March 28, 2025 (Kenya Gazette Notice No. 4069) in response to a directive from President William Ruto, who ordered the Ministry of Health to expedite the settlement of all legitimate medical claims.
According to the directive, hospitals with claims of Sh10 million and below - representing 91 percent of contracted facilities - will receive full payment immediately.
The remaining nine percent, with larger claims above Sh10 million, will undergo a thorough verification process within the 90-day timeframe.
