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The government has directed the Ministry of Health to pay all hospitals with claims below Sh10 billion—accounting for 91 percent of all contracted facilities.
The move comes as the government seeks to reform the country’s health financing framework and address long-standing inefficiencies in claim settlements.
Cabinet Secretary for Health, Aden Duale said hospitals with claims above this threshold, representing the remaining 9 percent, will undergo a rigorous verification process within 90 days.
Speaking during the official launch of the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee, the CS noted that this marks a critical step toward settling Sh33 billion in unpaid claims owed to healthcare providers.
“This Committee has been established to provide an independent, thorough, and transparent review of medical claims submitted to the defunct NHIF which, to date, remain unpaid,” Duale said.
The committee, gazetted under Kenya Gazette Notice No. 4069 of 28th March 2025, has been tasked with verifying outstanding claims submitted to the now defunct NHIF.
Duale outlined the committee’s core responsibilities, which include scrutinizing and verifying the authenticity of all pending medical claims as well as recommending action on fraudulent, false, or exaggerated claims.
Other duties will be making proposals to prevent future accumulation of unverifiable claims and ensuring value for money and transparency in service payments.
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According to Duale, “The available records indicate that the defunct NHIF owes Health Care Providers approximately Sh33 billion.”
He urged the committee to be meticulous, noting that only genuine claims should be approved for payment.
He also expressed concern about several irregularities that have plagued the system, including facilities offering services without valid contracts or beyond their capacity, doctors billing for procedures outside their specialization, and exaggerated billings beyond NHIF tariffs.
The CS also pointed to manipulation of patient and dependent records, claims submitted by non-existent facilities, duplicated and unsupported claims, system manipulation, and prolonged unwarranted hospital stays that have led to the accumulation of the debt.
“Let me emphasize that after verification, all genuine claims of healthcare providers will be paid, and this Committee will be held responsible for payment made to services not provided,” Duale stated.
The CS expressed full confidence in the leadership of the committee, chaired by Mr. James Masiro Ojee and deputized by Dr. Anne Wamae.
The members, drawn from various professional backgrounds, will serve for a period of three months.
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