Health Cabinet Secretary Aden Duale has announced that the government will pause payment of Ksh 30 billion owed by the defunct National Health Insurance Fund (NHIF) to hospitals until submitted claims are fully verified.
Addressing the media on Tuesday, September 16, 2025, Duale explained that the suspension is aimed at ensuring accountability and eliminating fraudulent or exaggerated claims.
He emphasised the need to differentiate the operations of the Social Health Authority (SHA) from the former NHIF, stressing that the outstanding bills will only be settled once the verification process confirms their legitimacy.
The CS assured hospitals that genuine claims would eventually be paid, but insisted that no funds would be released without thorough checks.
This, he noted, is part of the government’s broader effort to strengthen transparency and restore trust in Kenya’s healthcare financing system.
“Tutafautishe SHA na NHIF, NHIF tukp na bill ya ksh30 billion, lakini tumesema we must verify those bills; if we can confirm that Ksh 30 billion is verified, the government will pay, but you must go through verification.”
This comes amid growing pressure from the Rural & Urban Private Hospitals Association of Kenya (RUPHA), which has repeatedly called on the government to settle large outstanding debts to health facilities.
On September 10, 2025, RUPHA appealed for the government to clear Ksh 33 billion owed by the National Health Insurance Fund.
In addition, RUPHA said that under the newer Social Health Authority (SHA) scheme, hospitals are owed Ksh 43 billion in backlog claims. The association has asked that at least half of the SHA arrears be paid immediately to ease the pressure.
They also raised concerns about what they describe as unfair rejections of claims under SHA, and proposed that rejected claims be reconsidered under “clarification” rather than outright rejection, with hospitals given two weeks to comply under the SHA contract.
Duale defended the verification requirement, saying the government cannot release public funds without confirming that claims are genuine.
He also emphasised that SHA is working with health facilities that submit verifiable claims, provide authentic treatment and use proper documentation.
He pointed out that some SHA claims, about Ksh3 billion, have been flagged for missing documentation. Others, approximately Ksh 2.1 billion, are under active investigation.
In addition, Ksh 10.6 billion has already been rejected due to fraud, including upcoding services, falsifying medical records, converting outpatient to inpatient cases, and claims for non-existent patients.
SHA scandals
More than 85 facilities are under probe. The Kenya Medical Practitioners and Dentists Council has also closed 544 unlicensed hospitals across the country. Duale stressed that only legitimate claims will be honoured.
On the legal front, the High Court earlier quashed Duale’s formation of an ad hoc verification committee for NHIF pending claims, ruling that it had usurped powers constitutionally reserved for the Auditor General.
The judge ruled that Duale had no authority to form such a committee via Gazette Notice.
Meanwhile, RUPHA has issued a 14-day go-slow notice over SHA’s withheld payments, citing the growing debt, which they estimate at Ksh 76 billion and warning that many hospitals are in financial distress, lacking operational funds, medicine, or staff.
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