The National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities and 47 Health Maintenance Organisations (HMOs) over various service breaches in 2024, in line with its operational guidelines.
This was disclosed in a statement issued on Sunday in Abuja by the NHIA’s Acting Director of Media and Public Relations, Emmanuel Ononokpono.
According to the statement, the sanctions followed investigations into 3,507 complaints received from enrollees under both the state and national health insurance schemes. Of these, 2,929 complaints, representing 84 percent, were successfully resolved. Most of the complaints were directed at healthcare providers.
A breakdown showed that 2,273 complaints were lodged against healthcare facilities, 1,232 against HMOs, and two against enrollees.
The NHIA’s 2024 Annual Complaints Report, compiled by its Enforcement Department under the Acting Director of Enforcement, Dr. Abdulhamid Habib Abdullahi, revealed that common complaints against healthcare providers included unavailability of medicines, denial of services, out-of-pocket charges for services covered under the scheme, and lack of payment narration.
Complaints against HMOs centered on delays or denial of referral authorization codes, slow settlement of reconciled payments, and failure to conduct quality assurance monitoring.
In response, the NHIA issued 84 warning letters to erring healthcare facilities, suspended four, and delisted six. A total of ₦4,375,500 was refunded to 54 enrollees by 39 healthcare providers. In addition, 35 HMOs were issued warning letters with corrective action directives, and 12 HMOs refunded ₦748,200 to 15 enrollees.
All complaints were responded to within the stipulated timeframe of 10 to 25 days, with an average resolution time of 15 days. Unresolved cases were given timely updates, and complaints were received through walk-ins, letters, emails, telephone calls, the NHIA Call Centre, and digital platforms.
The NHIA’s Complaints and Grievance Management Protocol outlines procedures and timelines for complaint resolution and includes escalation steps for complex or unresolved issues.
The Director General of NHIA, Dr. Kelechi Ohiri, said the sanctions underscore the agency’s commitment to accountability, quality service delivery, and trust in the health insurance system. He emphasized that enrollees deserve the best possible care and that the NHIA would not tolerate substandard services.
He also noted that with the recent upward revision of capitation and fee-for-service payments—the first in 12 years—providers must now demonstrate improved service delivery.
To reduce delays in accessing care, the NHIA has mandated that HMOs issue referral codes within one hour. If not met, providers are directed to proceed with treatment according to NHIA protocols.
The agency reaffirmed its commitment to transparency and improvement, aligning with President Bola Ahmed Tinubu’s vision of achieving Universal Health Coverage (UHC) for all Nigerians.
