The National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities (HCFs) and 47 Health Maintenance Organisations (HMOs) for various service delivery breaches in 2024.
This was disclosed in the Authority’s 2024 Annual Complaints Report released by its Enforcement Department, under the leadership of Acting Director, Dr. Abdulhamid Habib Abdullahi.
The report revealed that the NHIA received and handled 3,507 complaints during the year, 2,929 of which were successfully resolved, representing 84 per cent of the cases.
According to the report, 2,273 complaints were lodged against healthcare facilities, 1,232 against HMOs, and only two against enrollees.
Key issues raised against healthcare providers included the unavailability of medicines, denial of services, and out-of-pocket billing for services that should be covered under the scheme. On the other hand, HMOs were flagged for delays in authorising referrals, late payments to facilities, and failure to monitor service quality.
In response, the NHIA issued 84 formal warnings to defaulting HCFs and directed 39 facilities to refund a total of ₦4,375,500 to 54 enrollees. Four healthcare facilities were suspended, while six were delisted from the NHIA platform. Among HMOs, 35 received warning letters and were ordered to institute corrective actions, while 12 were mandated to refund N748,200 to 15 enrollees.
The report noted that all complaints were investigated within the standard response time of 10 to 25 days, with an average resolution period of 15 days.
Director General of NHIA, Dr. Kelechi Ohiri, emphasised that the sanctions strengthened transparency, protected enrollees, and fostered trust in the system.
“Enrollees deserve the best care, and we will continue to ensure they get it,” Dr Ohiri stated. “These sanctions signal that NHIA will not tolerate substandard services.”
He commended healthcare providers who have remained committed to delivering quality care. He noted that recent capitation and fee-for-service rates, the first in 12 years, place a greater responsibility on providers to provide improved services.
NHIA has also introduced a one-hour referral code response rule for HMOs. Where HMOs fail to respond within the stipulated time, healthcare providers are authorised to proceed with treatment based on predefined protocols.
The NHIA’s complaint and grievance management system has been praised for its efficiency. The 2024 report highlights multiple access channels, including physical visits, letters, email, phone, and the NHIA call centre.
The authority reaffirmed its commitment to supporting President Bola Ahmed Tinubu’s goal of achieving Universal Health Coverage (UHC), promising to continue implementing reforms that ensure equitable and quality healthcare for all Nigerians.
