CS Duale vows to pay only verified NHIF claims as hospitals threaten strike
In a statement on September 10, RUPHA appealed for immediate settlement of Sh33 billion in NHIF arrears, warning that financial strain has pushed many facilities to the brink, affecting service delivery and millions of Kenyans.
Health Cabinet Secretary Aden Duale has maintained that the government will not release the Sh30 billion owed to the defunct National Health Insurance Fund (NHIF) until all claims presented are fully verified, despite a looming strike.
Addressing the media on Tuesday, Duale said the Ministry of Health (MoH) is committed to safeguarding public funds, stressing that payment will only be made once the legitimacy of the claims has been confirmed.
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“We must verify those bills; if we can confirm that Sh30 billion is verified, the government will pay, but you must go through verification,” he said.
His remarks come in the wake of pressure from the Rural Private Hospitals Association of Kenya (RUPHA), which has been urging the government to clear billions owed to hospitals.
In a statement on September 10, RUPHA appealed for immediate settlement of Sh33 billion in NHIF arrears, warning that financial strain has pushed many facilities to the brink, affecting service delivery and millions of Kenyans.
“Please pay the Sh33 billion NHIF debt owed to all hospitals in Kenya,” the association said.
The group also flagged Sh43 billion owed by the Social Health Authority (SHA) and called on the government to pay at least half of the amount to ease the financial burden.
“Pay 50 per cent of the 43B SHA debt,” RUPHA said, while also condemning massive claim rejections under SHA, which it said were crippling hospitals.
“Convert massive claim rejections to ‘Clarification’ and give hospitals two weeks to comply as per the SHA contract,” it added.
Speaking in Vihiga, Duale revealed that his ministry is probing fraudulent claims worth billions submitted through SHA.
“The data we have is not with the people on TV. Doctors are happy. The only people complaining are cartels. Their files are already with the DCI,” he said, confirming that names of facilities involved have been forwarded to the Directorate of Criminal Investigations.
According to the CS, Sh3 billion in SHA claims is under review due to missing documents, while Sh2.1 billion is under active investigation. Another Sh10.6 billion has already been rejected over fraudulent practices, including upcoding of services, falsifying medical records, converting outpatient cases into inpatient admissions and billing for non-existent patients.
More than 85 health facilities remain under probe, while the Kenya Medical Practitioners and Dentists Council (KMPDC) has closed 544 unlicensed hospitals nationwide. Duale stressed that only legitimate claims would be honoured.
“We must pay only genuine claims. Do not attempt backdating. Reforms are unstoppable and cartels will not derail us,” he warned.
He emphasised that the reforms are designed to protect taxpayers’ money and ensure patients receive quality care.
RUPHA, however, has already issued a 14-day strike notice to SHA, citing crippling debt and rejected claims. Chairperson Brian Lishega said on September 5 that hospitals are in a financial crisis, with Sh76 billion owed to them. He warned that many facilities lack medicines, staff and operational funds.
“Kenyan hospitals remain in severe financial distress due to delayed and inadequate reimbursements by the Social Health Authority. This is the lived reality of hospitals, not the narrative of ‘timely payments’ presented to the public,” he said.
Lishega noted that half of the claims from Level 2 to Level 4 hospitals remain unpaid, while payout ratios for general inpatient and surgical claims are as low as 10 to 20 per cent. By the end of August, healthcare providers had submitted claims worth Sh96.2 billion, but only Sh53 billion had been paid, leaving a Sh43 billion shortfall.
He further questioned SHA’s financing model, pointing out that it collects Sh5.4 billion monthly against claims averaging Sh8.7 billion, leaving a Sh3.5 billion deficit. He also accused the government of disregarding a presidential directive issued in March to settle NHIF debts below Sh10 million.
The unpaid balances cut across both public and mission hospitals, with Kenyatta National Hospital owed Sh1.58 billion, Moi Teaching and Referral Hospital Sh1.23 billion, Kenyatta University Teaching, Referral and Research Hospital Sh540 million and Nakuru County Hospital Sh297 million.
Lishega criticised SHA for rejecting claims months after submission and arbitrarily downgrading and suspending facilities, saying such actions violate the Constitution and the Fair Administrative Action Act.
He demanded five urgent interventions, including immediate settlement of NHIF liabilities as per the presidential directive, clearance of at least half of the Sh43 billion SHA arrears, creation of a claims clarification mechanism, formation of a dispute resolution tribunal and publication of claims data.
“Without action, access to healthcare will collapse under the weight of debt. A Marshall Plan is urgently required to clear debts and redesign SHA sustainably,” Lishega warned.
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