MPs demand SHA clears Sh10 billion in pending NHIF bills within three months
The committee, chaired by Seme MP James Nyikal, noted that reimbursements under SHA have been inconsistent, with some facilities recording no disbursements at all.
Members of Parliament (MPs) now want the Social Health Authority (SHA) to clear Sh10 billion in pending NHIF bills within three months, warning that delays are putting hospitals’ financial stability and service delivery at risk.
In its report assessing SHA’s operations one year after its establishment, the National Assembly Committee on Health found that hospitals across the country are owed millions of shillings in verified payments from the now-defunct National Health Insurance Fund (NHIF).
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Mbagathi Hospital alone is awaiting Sh279.5 million, while St Elizabeth is owed Sh2.6 million and Matata Nursing Home Sh53 million. Rachuonyo County Hospital has pending bills of Sh22.4 million, Nyandiwa Level 4 Hospital Sh5.6 million, and St Mary’s Hospital in Mumias Sh143 million.
Nyeri County Referral Hospital is still waiting for Sh156.6 million, Sipili Maternity and Nursing Home Sh9 million, PCEA Tumutumu Hospital Sh89.8 million and Nyahururu County Referral Hospital Sh36.7 million.
The committee, chaired by Seme MP James Nyikal, noted that reimbursements under SHA have been inconsistent, with some facilities recording no disbursements at all.
"A substantial backlog of arrears inherited from the defunct NHIF remains unresolved. Approved but unpaid claims continue to accumulate across facilities, further straining the financial stability of hospitals," reads the report.
It also highlighted payment errors that have worsened hospitals’ financial strain. Nyeri County Referral Hospital, for example, lost over Sh16 million to a neighbouring private hospital due to processing mistakes, and recovery efforts were unsuccessful.
The Committee has now asked the National Treasury to invoke Article 223 of the Constitution to ensure the funds are released without parliamentary approval, stressing that unpaid debts are slowing the transition of hospitals to SHA.
"The National Treasury should invoke Article 223 of the constitution to facilitate the settlement of outstanding NHIF debts of up to Sh10 billion, thereby ensuring the financial stability of health facilities and restoring confidence in the transition to the Social Health Authority," reads the report.
Article 223 allows the government to withdraw funds from the Consolidated Fund Services (CFS) without parliamentary approval, up to 10 per cent of the approved budget, for emergencies or unforeseen circumstances. Parliament must approve such spending within two months of the first withdrawal.
The committee also called on SHA’s CEO to immediately disburse pending reimbursements to prevent service disruptions.
"As verification of the defunct NHIF debt continues, the Chief Executive Officer of SHA should immediately disburse all pending SHA reimbursements to prevent service disruptions," reads the report.
The committee condemned the high rate of claim rejections even when facilities provide adequate documentation.
"Hospitals reported the absence of a clear and transparent mechanism for claim resubmission, with feedback on rejected claims often delayed well beyond the 90-day statutory period," reads the report.
To improve efficiency, the committee directed SHA’s CEO to enforce the 90-day claims settlement rule and issue standardised remittance advice detailing paid, pending and rejected claims, with documented reasons.
"Rejected claims shall include clear justification and allow for resubmission through the digital portal. The CEO is to submit a compliance and implementation report, including a comprehensive financial statement of all SHA revenues and expenditures within three months," reads the report.
The committee also instructed the CEO to reinstate mandatory human verification for AI-flagged claims within 45 days and ensure prompt investigation and prosecution of fraud.
"Where fraud or non-compliance is detected, the CEO of SHA should initiate investigations and ensure that any identified fraud is prosecuted at the individual level while ensuring that no health facility is closed unless care continuity is guaranteed," the Committee said.
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