By peterside Rejoice
The National Health Insurance Authority (NHIA) has sanctioned a total of 49 healthcare facilities (HCFs) and 47 Health Maintenance Organisations (HMOs) in 2024 for violating its operational guidelines.
This was disclosed in a statement issued on Sunday by the NHIA Acting Director of Media and Public Relations, Emmanuel Ononokpono, citing findings from the agency’s 2024 Annual Complaints Report.
The statement highlighted recurring issues against HCFs including unavailability of medicines, denial of services, illegal out-of-pocket charges for covered treatments, and lack of payment narration. For HMOs, common infractions included delays or denials of referral authorisation codes, late settlement of reconciled payments, and failure to monitor quality assurance in facilities.
In total, the NHIA said it handled 3,507 complaints during the year under review, with 84 percent (2,929) of the cases resolved most of them against healthcare facilities.
“A breakdown shows that 2,273 complaints were against healthcare providers, while 1,232 were against HMOs. Only two complaints were recorded against enrollees,” the statement read.
As part of the enforcement outcomes, 84 warning letters were issued to erring HCFs, four facilities were suspended, and six were delisted. A total of 54 enrollees received refunds amounting to ₦4.38 million from 39 health facilities.
Similarly, 35 HMOs received formal warnings and were directed to take corrective actions, while 12 HMOs were ordered to refund ₦748,200 to 15 enrollees.
All complaints were reportedly investigated within 10 to 25 days the NHIA’s standard resolution window with an average resolution time of 15 days. Where cases exceeded the time limit, explanations were provided to complainants.
The complaints were submitted via in-person visits, letters, emails, telephone, and the NHIA call centre.
NHIA Director General, Dr. Kelechi Ohiri, stated that the sanctions reinforce the agency’s commitment to transparency, accountability, and improved healthcare delivery under the National Health Insurance Scheme.
“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 NHIA will not tolerate substandard services.”
He added that new policies have been implemented, including a directive that mandates HMOs to issue referral codes within one hour. If no code is received within that period, providers are expected to proceed with treatment under emergency protocols.
Ohiri reaffirmed the agency’s dedication to achieving Universal Health Coverage, in line with President Bola Tinubu’s healthcare vision.
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