Duale formalises the NHIF pending medical claims verification committee
Health Cabinet Secretary Aden Duale has officially inaugurated the National Health Insurance Fund (NHIF) pending medical claims verification committee.
The committee, chaired by James Masiro, will be based at Afya House, Nairobi.
According to a statement released by the Ministry of Health (MoH), the committee’s main role is to examine the authenticity of all pending medical claims made to NHIF between July 1, 2022, and September 30, 2024.
Task at hand
The team has been tasked with establishing a clear and robust system for checking these claims in detail. Their goal is to determine which claims are genuine and to identify any that are false, exaggerated, or fraudulent. Once verified, the committee will make recommendations to the Ministry of Health on how to settle the valid claims and what actions should be taken against any illegal or dishonest submissions.
“Scrutinize and verify the authenticity of all pending medical claims. Establish clearly defined criteria and robust framework for detailed claims examination and analysis of such pending medical claims to determine the genuineness of each or otherwise. Identify and recommend actions on any fraudulent, false, or exaggerated claims,” a statement by MOH read in part.
They will also propose reforms that will help prevent such issues in the future, ensuring better transparency and accountability within the health insurance system.
“Identify any cases where there may have been corrupt, fraudulent and false medical claims and make appropriate recommendations to the relevant Government Agencies. Make recommendations to MoH on the necessary actions to be taken for satisfactory disposal or settlement of the identified pending medical claims. Propose reforms or measures that will ensure/prevent the recurrence of unverified or accumulated claims in the future,” the statement read further.
Presiding over the inauguration, CS Duale emphasized the importance of the committee’s work in ensuring public funds are used responsibly.
“Presided over the inauguration of the NHIF Pending Medical Claims Verification Committee, chaired by Mr. James Masiro, at Afya House, Nairobi. The Committee is tasked with scrutinizing and verifying NHIF medical claims submitted between 1st July 2022 and 30th September 2024,” Duale stated.
“It will also advise the Ministry on the settlement of verified claims. I urged the members to conduct a rigorous, objective review, guided by transparency, accountability and value for money.”
He acknowledged the financial pressure many healthcare providers are currently facing but stressed that government money must lead to real health outcomes. He noted that this effort is part of the government’s commitment to Universal Health Coverage under the Bottom-Up Economic Transformation Agenda (BETA).
“While the Government acknowledges the financial strain on healthcare providers, public funds must deliver real health outcomes under our Universal Health Coverage agenda through the Bottom-Up Economic Transformation Agenda (BETA),” he added.
The newly formed committee is expected to play a key role in cleaning up the claims backlog in the defunct NHIF.
Members of the verification committee 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.
They will be assisted by a secretariat comprising Peter Kitheka (Head of the Secretariat), Shawn Mogaka, Consolata Ogot (Dr.), Emmanuel Ayodi Lusigi (Dr.), Halima Yussuf and Wilbert Kurgat.
