The National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities and 47 Health Maintenance Organisations (HMOs) across the country for breaching its operational guidelines in 2024 as part of renewed efforts to improve service quality for enrollees.
The sanctions were imposed following investigations into 3,507 complaints received from Nigerians enrolled in state and national health insurance schemes.
The complaints, handled by the Enforcement Department of the (NHIA), revealed persistent issues such as medicine unavailability, denial of care, unlawful out-of-pocket charges by healthcare facilities, and failure to provide payment narrations.
Violations by the HMOs include delays or denials in issuing referral authorization codes, slow settlement of reconciled payments, and failure to monitor service quality in contracted facilities.
According to the 2024 Annual Complaints Report released by Acting Director of Enforcement, Dr Abdulhamid Abdullahi, 84% of the complaints were resolved within the standard resolution time of 10 to 25 days, with an average resolution period of 15 days.
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Meanwhile, 35 HMOs were issued warning letters, and 12 HMOs were directed to refund ₦748,200 to 15 enrollees.
Out of the 2,273 complaints lodged against HCFs and 1,232 against HMOs, the NHIA issued 84 formal warnings to healthcare providers.
Four facilities were suspended, six delisted, and 54 enrollees received refunds totaling ₦4.38 million from 39 facilities.
NHIA Director General, Dr Kelechi Ohiri, emphasized that the sanctions underscore the authority’s commitment to accountability and quality care.
The authority has also introduced a new policy mandating that HMOs respond to referral requests within one hour and if there is no response, healthcare providers are to proceed with treatment based on approved protocols.
The NHIA report reaffirmed the agency’s commitment to transparency, improved service delivery, and achieving Universal Health Coverage in line with the vision of President Bola Tinubu.
(Editor: Okechukwu Eze)
