Task force launched to audit over Sh33 billion in NHIF claims

KENYA – Kenya’s healthcare system is set for a significant overhaul as Health Cabinet Secretary Aden Duale inaugurates a special task force to audit over Sh33 billion (US $254.4 million). in pending medical claims owed by the National Health Insurance Fund (NHIF).

This initiative, launched on Monday, is a direct response to a presidential directive aimed at streamlining claim verification processes, restoring accountability, and enhancing transparency in health financing.

The newly formed task force is chaired by James Masiro and includes professionals drawn from the private sector, county governments, and the Social Health Authority (SHA).

With a strict 90-day mandate, the committee is tasked with reviewing medical claims submitted between July 1, 2022, and September 30, 2024.

Their primary objective is to sift through the pending claims, identifying and verifying those that are genuine while filtering out exaggerated, fraudulent, or false submissions. A key aspect of the task force’s mandate is the prioritization of claims based on their value.

According to Cabinet Secretary Duale, the President has directed that all verified claims valued below Sh10 million (US $77,097)—which make up 91 percent of the total pending bills—should be settled immediately.

The remaining nine percent of claims, those exceeding Sh10 million, will undergo thorough verification and are expected to be cleared within the 90-day period.

This structured approach is designed to ensure that the bulk of the pending financial liabilities are addressed promptly, thereby alleviating pressure on the NHIF and boosting public confidence.

The task force’s formation was highlighted during the launch event in Nairobi, where several key stakeholders were present.

Among them were Mary Muthoni, Principal Secretary for the State Department of Public Health and Professional Standards; Health Director General Dr. Patrick Amoth; and members of the SHA board.

Their collective presence underscored the government’s commitment to elevating the standards of healthcare delivery and financial management across the nation.

During his address, Duale stressed the importance of the exercise. “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,” he assured.

Duale further outlined the core focus areas for the audit, which include scrutinizing services offered without valid contracts, facilities operating beyond their capacity, doctors billing outside their areas of specialization, inflated receipts and tariffs, as well as suspected cases of data or system manipulation.

The review will also address issues such as duplicate records, unsupported surgeries, unwarranted hospital stays, and claims from non-existent facilities.

Task force chairperson James Masiro acknowledged the scale of the assignment, emphasizing that the team is fully committed to the rigorous process ahead.

“This is an enormous task, but we are fully committed. Teamwork will be crucial,” he said. Masiro also stressed the need for professionalism, fairness, and transparency throughout the review process and confirmed that regular updates will be provided to the Ministry of Health.

This decisive move comes at a time when Kenya’s healthcare sector faces numerous challenges, including underfunded facilities and systemic inefficiencies.