The National Health Insurance Authority (NHIA) sanctioned 49 healthcare facilities (HCFs) and 47 health maintenance organisations (HMOs) in 2024 for infractions bordering on poor quality of service to enrollees, in accordance with its operational guidelines.

In a statement yesterday, the body said the action followed investigations into complaints received from patients enrolled into the state and national health insurance schemes.

It said it 3,507 complaints were handled during the period, out of which 2,929 complaints (84 per cent)—the majority of which were against HCFs—were resolved.

According to the agency, the key issues recorded in the complaints against HCFs were the unavailability of medicines, denial of services, out-of-pocket payment for cov ered services, and non-provision of payment narrations.

It said: “For the HMOs, the issues related to delays or denials of referral authorization codes, delays in settlement of agreed reconciled payments, and refusal to monitor quality assurance in facilities.”

These were some of the highlights of the 2024 Annual Complaints Report produced by the Enforcement Department under the acting Director of Enforcement Abdulhamid Abdullahi.

The report was issued in compliance with the NHIA Act 17 of 2022, which requires NHIA to establish mechanisms for receiving and resolving complaints by members of the schemes and healthcare facilities.

The NHIA said: “Based on the outcome of investigations, various sanctions were imposed on erring healthcare providers where indicated. “Eighty-Four formal warnings were issued to HCFs, while 54 enrollees received refunds of N4,375,500 from 39 HCFs.”