Health CS Duale inaugurates NHIF task force to audit pending claims worth Sh33 billion

Health Cabinet Secretary Aden Duale on Monday inaugurated a special task force to audit over Sh33 billion in pending medical claims owed by the National Health Insurance Fund (NHIF).

Speaking during the launch on Monday, CS Duale said the formation of the task force follows a presidential directive aimed at streamlining claim verification, restoring accountability, and enhancing transparency in health financing.

The committee, chaired by James Masiro, comprises professionals from the private sector, county governments, and the Social Health Authority (SHA). It has been granted a 90-day window to complete its assignment.

"The President has directed that the government immediately settle all verified claims below Sh10 million, which constitute 91 percent of the pending bills. The remaining nine percent, involving claims above Sh10 million, will be verified and cleared within the 90 days," said Duale.

He added that the task force would scrutinise claims submitted between July 1, 2022, and September 30, 2024.

Also present at the launch were the Principal Secretary for the State Department of Public Health and Professional Standards, Mary Muthoni, Health Director General Dr. Patrick Amoth and the SHA board members.

Outlining the task force's mandate, Duale said the team will develop a robust framework for analyzing all pending claims to distinguish genuine from exaggerated, fraudulent, or false submissions. The committee is expected to make appropriate recommendations to the Ministry of Health for action.

"This committee must verify all claims with utmost integrity and only recommend those that are legitimate," said the CS. "Key focus areas will include services offered without valid contracts, facilities operating beyond capacity, doctors billing outside their area of specialization, inflated receipts and tariffs, and suspected cases of data or system manipulation."

He noted that some flagged claims involve duplicated records, unsupported surgeries, unwarranted hospital stays, and bills from non-existent facilities.

"We are taking this bold step to restore public confidence in the health system. I have full confidence that the task force will deliver. All verified and legitimate claims will be paid," Duale assured.

He further called on all stakeholders to support the task force, stressing that professionalism, fairness, and transparency must guide the process.

Task force chairperson James Masiro acknowledged the scale of the assignment but expressed confidence in the team's ability to deliver.

"This is an enormous task, but we are fully committed. Teamwork will be crucial," he said. "We understand the sensitivity of this process and the need to act professionally to earn public trust. We recognise that people are suffering. Our work must help alleviate that suffering, not contribute to it."

He added that the team will provide regular updates to the Health Ministry throughout the three months and will seek guidance should any delays arise.

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"We are determined to fulfill this mandate as outlined in the gazette notice," he said.