Health Ministry launches NHIF committee to verify pending claims

Muhati Venesa-KNA

The Ministry of Health has launched the National Health Insurance Fund (NHIF) Pending Claims Verification Committee.

The committee’s main role is to scrutinize and validate outstanding medical claims submitted between July 1, 2022, and September 30, 2024.

The committee will establish a clear framework to assess the authenticity of each claim, recommend action on fraudulent submissions, and propose reforms to prevent future accumulation of unverified claims.

“Hospitals with claims below Sh10 million will be paid without delay, while the remaining nine per cent, whose claims exceed Sh10 million, will undergo a thorough verification exercise within 90 days, after which a payment plan will be agreed upon for all genuine claims,” Health Cabinet Secretary Adan Duale said during the launch.

Duale emphasized that the government is committed to settle all legitimate claims. Addressing concerns over financial constraints in the sector, he acknowledged the challenges facing key healthcare providers but insisted that fiscal prudence must prevail.

“I challenge this committee to identify and root out any fraud or corruption in the healthcare financing system, and where wrongdoing is found, you must recommend the necessary disciplinary or legal action without fear or Favor,” said the CS.

Reiterating his stance, Duale warned that the committee would be held accountable for any payments made for services not rendered.

“Every shilling must count value for money, transparency, and accountability are non-negotiable,” he affirmed.

He also urged healthcare providers, NHIF management, oversight agencies, and the public to support the committee’s work in fostering integrity and fairness.

Committee chairperson James Masiro stated its commitment to delivering accurate, risk-based verification.