Duale urges Claims Committee to thoroughly scrutinize pending NHIF bills

The committee led by chairperson James Ojee is tasked with examining pending bills accrued from the defunct National Hospital Insurance Fund (NHIF) from July 1, 2022 to September 30, 2024, and making recommendations to the Ministry of Health on settlement of the debt.

During the inauguration of the committee on Monday, Health Cabinet Secretary Aden Duale tasked the group with determining the genuineness or otherwise of each medical bill before making payment recommendations. 

“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. 

According to the Health Ministry, available records indicate that the defunct NHIF owes Health Care Providers approximately Ksh. 33 billion.

The Ojee-led committee is therefore expected to identify any fraudulent, false, or exaggerated claims and recommend necessary actions to government. 

It will also propose reforms to prevent the recurrence of unverified or accumulated claims in the future.

To unearth fraudulent claims, the committee will look at cases where facilities offered services without valid contracts or beyond the hospital level. It will also look at exaggerated invoices, unwarranted admissions and prolonged hospital stays, unsupported surgeries, doctors claiming services outside their scope, duplication of claims and manipulation of records. 

Other members of the committee that will serve for 3 months include; Anne Wamae (vice-chairperson), Edward Bitok, Meshack Matengo, Meboh Awour, Tom Nyakaba, Catherine Bosire, Paul Wafula, Catherine Mungania, James Oundo, Jackline Njiru, Judith Awinja and David Dawe.