The National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities (HCFs) and 47 Health Maintenance Organisations (HMOs) in 2024 for violating its service guidelines.
According to a statement released on Sunday by the NHIA’s Acting Director of Media and Public Relations, Emmanuel Ononokpono, the sanctions followed over 3,500 complaints received by the authority during the year. Common issues against healthcare providers included lack of medicines, denial of service and asking patients to pay for treatments covered by insurance. For HMOs, delays in authorising referrals and late payments to providers were major concerns.
Out of the 3,507 complaints handled, 84% were resolved, with most complaints (2,273) directed at HCFs and 1,232 at HMOs. Only two were filed against enrollees.
The NHIA issued 84 formal warnings to healthcare facilities, ordered 39 of them to refund a total of ₦4.38 million to 54 enrollees, suspended four facilities and delisted six. For HMOs, 35 were warned and 12 were directed to refund ₦748,200 to 15 enrollees.
All complaints were addressed within 10 to 25 days, with an average resolution time of 15 days. The NHIA said it followed strict complaint management protocols and ensured that unresolved cases were continuously followed up.
NHIA Director General, Dr. Kelechi Ohiri, said the sanctions are part of the agency’s efforts to improve service quality and build public trust. He added that with increased provider payments the first in 12 years better service is expected.
To further improve service delivery, NHIA has also issued a new policy requiring HMOs to provide referral codes within one hour. If no response is received, hospitals are expected to begin treatment based on an agreed emergency protocol.
Dr. Ohiri reaffirmed the NHIA’s commitment to accountability and its goal of achieving Universal Health Coverage (UHC), in line with President Bola Tinubu’s healthcare vision for Nigerians.