The High Court in Eldoret has ruled that the formation of the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee was unlawful.
In a court ruling on August 13, the court stated that the move breached several constitutional provisions safeguarding patients’ right to privacy.
Additionally, in his judgment, Justice Nyakundi ruled that the committee, constituted through a Gazette Notice on March 28, 2025, noted that the Constitution does not provide for the establishment of such a body.
“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,” Justice Nyakundi stated.
The ruling follows a petition filed by four individuals, among them Nakuru-based surgeon Dr. Benjamin Gikenyi, challenging the legality of the committee appointed to audit pending NHIF claims.
Court Declares NHIF Pending Bills Committee Unconstitutional
He ruled that its establishment went against the spirit of the Constitution, adding that its powers were exercised beyond what the law allows.
“The petitioners have a legitimate expectation that all state officers and state organs had to follow the constitution, including the statutory requirements of ensuring that they should never perform functions of independent commissions and offices, and if there was any contrary to this expectation (the CS) violated the legitimate expectations of Kenyans,” he added.
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Gikenyi argued in the petition that if an audit was required, the Health Cabinet Secretary should have engaged the Auditor General, as mandated by law, rather than creating another body to perform functions reserved for the constitutionally established office.
Justice Nyakundi observed that, although the CS may have acted with good intentions, but the move bypassed established constitutional oversight institutions — including the Directorate of Internal Audit and the Office of the Auditor-General — tasked with protecting public resources.
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Duale Inaugurates NHIF Pending Medical Claims Verification Committee
In March, Health Cabinet Secretary Aden Duale appointed the committee to audit pending bills owed to hospitals by the now-defunct NHIF, which was replaced by the Social Health Insurance Fund (SHIF) in October last year.
The committee was tasked with scrutinizing and verifying pending medical claims submitted to the National Health Insurance Fund (NHIF) between July 1, 2022, and September 30, 2024.
It was also expected to advise the Ministry of Health on the settlement of verified claims, alongside other assigned duties.
“This Committee is a critical step towards restoring public trust in our health financing system. We must ensure that every shilling spent delivers meaningful health outcomes, in line with the Government’s commitment to Universal Health Coverage under the Bottom-Up Economic Transformation Agenda (BETA),” said Duale.
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