The government has taken a significant step towards addressing the growing backlog of unresolved medical claims within the National Health Insurance Fund (NHIF).
The Cabinet Secretary for Health, Aden Duale, has officially announced the formation of the National Health Insurance Fund Pending Medical Claims Verification Committee, aimed at clearing the existing claims backlog and ensuring that future claims are processed efficiently and transparently.
The newly appointed 19-member committee, chaired by James Masiro Ojee, will be tasked with reviewing all pending medical claims accumulated between July 1, 2022, and September 30, 2024.
The team’s mandate includes scrutinizing each claim’s validity, ensuring legitimate claims are settled promptly, and identifying any fraudulent or erroneous submissions.
The committee will also recommend long-term reforms to prevent future backlogs and improve NHIF’s claims process, as outlined in the Gazette Notice issued on March 28, 2025.
The full committee includes Chairperson James Masiro Ojee, Vice-Chairperson Dr. Anne Wamae, and members such as Edward Kiplimo Bitok, Meshack Matengo, Meboh Atieno Awour, Tom Nyakaba, Catherine Karori Bosire, Paul Wafula, Catherine Mungania, James Oundo, Jackline Mukami Njiru, Dr. Judith Awinja, David Dawe, Peter Kitheka (Head of Secretariat), Shawn Mogaka, Dr. Consolata Ogot, Dr. Emmanuel Ayodi Lusigi, Halima Yussuf, and Wilbert Kurgat.
This team will review pending claims and ensure that only legitimate claims are processed.
The committee will also investigate fraudulent claims, working closely with law enforcement agencies and relevant government bodies to uncover any instances of misconduct or corruption.
By addressing these issues, the committee aims to restore trust in the NHIF system and ensure resources are directed to legitimate medical needs.
Apart from addressing the current backlog, the committee will recommend reforms to streamline the NHIF claims process, focusing on reducing delays and enhancing transparency.
The committee’s goal is to create a more efficient, accountable, and transparent system that avoids future backlogs.
The committee has a three-month mandate, starting from the date of the Gazette Notice, to complete its work. It is expected to submit a final report with recommendations to the Ministry of Health by June 28, 2025.
CS Duale urged all stakeholders, including healthcare providers and NHIF beneficiaries, to cooperate with the committee.
He emphasized that this process is a collective effort aimed at ensuring NHIF serves its mandate effectively, with transparency and accountability.
“I urge all Kenyans and healthcare providers to support the committee’s work. This is a collective effort aimed at ensuring that NHIF serves its mandate effectively,” Duale said.
The formation of this committee comes at a time when NHIF has faced scrutiny over delayed claim settlements.
It is hoped that the initiative will restore confidence in NHIF, ensuring it operates more efficiently and serves its beneficiaries in a timely manner.
