The High Court in Eldoret has nullified the creation of the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee, terming it illegal.
In his ruling on Wednesday, August 13, Justice Reuben Nyakundi said the committee’s formation went against Article 31 of the Constitution when read together with the Social Health Authority Act.
The court determined that neither the supreme law nor the statute allowed for the creation of such a panel.
“There was no legal basis for the establishment of the committee. The transitional provisions of the Social Health Insurance Act do not provide for the formation of any committees to establish the liabilities of the NHIF,” the judge ruled.
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Health Cabinet Secretary Aden Duale announced the format of the committee earlier in the year to address the backlog of unsettled medical claims.
In a statement on Saturday, March 29, Duale said the committee would be chaired by James Masiro Ojee, alongside Vice-Chairperson Dr. Anne Wamae and 17 members.
According to the CS, their primary task was to scrutinize all pending claims accumulated between July 1, 2022, and September 30, 2024.
The committee would also evaluate the legitimacy of the claims, ensuring that genuine submissions are settled while fraudulent or irregular ones are flagged for appropriate action.
“The Government has constituted the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee to address the backlog of unsettled medical claims.
"It will make recommendations on the settlement of genuine claims while identifying and flagging any fraudulent or irregular submissions for appropriate action," he said.
Beyond resolving existing cases, the committee was also been tasked with proposing long-term reforms aimed at preventing future claim backlogs.
