A committee formed to vet unresolved National Health Insurance Fund (NHIF) medical claims has been struck down by the High Court in Eldoret, which found its creation to be unconstitutional and without legal basis.
Justice Reuben Nyakundi delivered the verdict in Constitutional Petition No. E011 of 2025, stating that the committee, established through Gazette Notice No. 4069 Vol. CXXVII No. 64 on March 28, 2025, violated fundamental rights, including the right to privacy guaranteed under Article 31 of the Constitution.
In his judgment, Justice Nyakundi declared, “That a declaration [be] and [is] hereby issued that the establishment of the National Health Insurance Fund (NHIF) Pending Medical Claims Verification Committee through Gazette Notice No. 4069 Vol. CXXVII No. 64 of 28th March 2025 was in contravention of Article 31 of the Constitution of Kenya 2010, as read with the Social Health Authority.”
The court found that the Cabinet Secretary for Health acted beyond the powers granted under both the Constitution and the National Government Coordination Act.
Justice Nyakundi described the move as a breach of “the letter and spirit of the Constitution,” pointing out that the committee’s mandate inevitably required access to identifiable patient information.
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The petitioners, Dr. Magare Gikenyi and three others, argued that the committee’s functions overlapped with the constitutional role of the Auditor-General, as outlined in Article 229(4)(g) and Section 7 of the Public Audit Act.
They said the creation of the body undermined independent oversight offices and breached the Public Finance Management Act as well as regulations set by the Digital Health Authority.
On the matter of patient data, the judge sided with the petitioners.
Even if patient records were anonymised, he noted, the process of confirming the legitimacy of claims would still involve retrieving identifiable medical details, thus infringing privacy rights.
Justice Nyakundi ordered the disbandment of the committee, prohibited the use of any of its work, and directed that all public money spent on it be refunded to the Consolidated Fund.
“This was a void decision — invalid from its inception — and from the standpoint of the Constitution, it has no legal effect,” he stated.
The Ministry of Health had appointed James Mariro to lead the body, which was to review claims filed between July 1, 2022, and September 30, 2024.
Its responsibilities included developing a framework for authenticating claims, recommending action against fraudulent submissions, and suggesting measures to prevent future backlogs of unverified claims.
With the court’s intervention, NHIF will now have to turn to constitutionally mandated institutions to handle pending claims, a move likely to reshape how such disputes are addressed in the future.
