National Health Insurance Authority

The National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities and 47 Health Maintenance Organisations (HMOs) across the country in 2024 for violating its operational guidelines.

In a statement released yesterday, the NHIA’s Acting Director of Media and Public Relations, Emmanuel Ononokpono, disclosed that the sanctions followed various complaints lodged by enrollees regarding service delivery under the health insurance scheme.

According to the statement, the breaches committed by healthcare facilities included the unavailability of prescribed medicines, denial of entitled services, unauthorised out-of-pocket demands from patients, and failure to provide payment narrations. HMOs, on the other hand, were accused of delayed or denied referral authorisation codes, late reconciliation payments, and poor quality assurance monitoring at healthcare centres.

“These are some of the highlights of the 2024 Annual Complaints Report produced by the Enforcement Department of the NHIA under Acting Director, Enforcement, Dr Abdulhamid Habib Abdullahi,” the statement noted.

The report revealed that the authority received a total of 3,507 complaints during the review period, out of which 2,929 — about 84 per cent — were successfully resolved.

A breakdown of the complaints showed that 2,273 were directed against healthcare facilities, while 1,232 targeted HMOs. Only two complaints were made against enrollees.

As part of the enforcement actions, 84 formal warnings were issued to defaulting healthcare providers, while 39 facilities were made to refund a total of ₦4,375,500 to 54 enrollees. In addition, four healthcare facilities were suspended and six others were delisted.

For HMOs, 35 received warning letters with directives to institute corrective measures, and 12 were ordered to refund a combined ₦748,200 to 15 affected enrollees.

The report also highlighted that all complaints received were handled within the NHIA’s standard response window of 10 to 25 days, with an average resolution time of 15 days for cases requiring investigation. In situations where timelines were exceeded, explanations were provided to complainants while resolution efforts continued.

Complaints were submitted through multiple channels, including in-person visits, written letters, emails, telephone calls, the NHIA call centre, and other official platforms.

Speaking on the significance of the report, NHIA Director General Dr Kelechi Ohiri emphasised that the complaints and sanctions process is central to improving quality of care, enhancing accountability, and building trust among enrollees.

“Enrollees deserve the best care, and we will continue to do our best to ensure they get it,” Ohiri said. “The sanctions are meant to send a clear message that the NHIA will not tolerate substandard service for enrollees.”

He commended service providers who have remained committed to delivering high-quality healthcare, noting that with the recent increase in capitation and fee-for-service payments — the first in 12 years — expectations for better patient care have also risen.

To improve service delivery further, the NHIA has issued a new policy requiring HMOs to respond to referral requests within one hour. In cases where a response is not received within the timeframe, providers are directed to proceed with treatment based on existing emergency protocols.

The authority reaffirmed that these measures align with President Bola Tinubu’s health sector reform agenda aimed at achieving Universal Health Coverage (UHC) and ensuring that Nigerians have equitable access to quality healthcare.

“The report demonstrates the commitment of the Authority to transparency, accountability, and continuous improvement in the provision of healthcare services,” the NHIA said.