Duale forms 19-member committee to review pending NHIF claims

Health Cabinet Secretary Aden Duale has appointed a committee to review pending bills owed to hospitals by the now defunct National Health Insurance Fund (NHIF), which the Social Health Insurance Fund (SHIF) replaced last October.

Duale, who took up the health docket on March 26 after a Cabinet reshuffle, announced the 19-member NHIF Pending Medical Claims Verification Committee in a March 28 Kenya Gazette notice.

James Ojee chairs the committee, with Anne Wamae as vice-chairperson. Its members are Edward Bitok, Meshack Matengo, Meboh Awour, Tom Nyakaba, Catherine Bosire, Paul Wafula, Catherine Mungania, James Oundo, Jackline Njiru, Judith Awinja and David Dawe.

At the same time, Peter Kitheka has been made the head of the committee’s secretariat, which is comprised of Shawn Mogaka, Consolata Ogot, Emmanuel Lusigi, Halima Yussuf and Wilbert Kurgat.

Duale tasked the team with “scrutinising and analysing” pending NHIF medical claims between July 1, 2022 and September 30, 2024, and “making recommendations to the Ministry of Health on settlement of the same.”

Other functions include establishing “clearly defined criteria for detailed examination and analysis of such pending medical claims” to determine their authenticity, recommending actions for claim settlement and proposing measures to avoid future claim piling.

“Identify any cases where they may have been corrupt, fraudulent and false medical claims and make appropriate recommendations to the relevant government agencies,” the notice reads.

The committee shall serve for three months.

Pending bills from the former public health scheme have caused a feud between private hospitals and the government; the facilities, earlier this month, briefly suspended offering services under SHIF.

The Health Ministry, however, criticised the move as blackmail.

The hospitals lifted the suspension after President William Ruto, on March 5, pledged his government would pay all facilities with pending NHIF claims under Ksh.10 million.

Hospitals with claims above that, Ruto said, would undergo a verification exercise that should be completed in 90 days, after which “a payment plan will be agreed on.”