The National Health Insurance Authority (NHIA) sanctioned 49 healthcare facilities and 47 Health Maintenance Organisations (HMOs) in 2024 for breaching operational guidelines, addressing complaints about service denials and unauthorized payments, the agency announced Sunday.
The NHIA’s 2024 Annual Complaints Report, issued by Acting Director of Enforcement Dr. Abdulhamid Habib Abdullahi, detailed 3,507 complaints, with 2,929 (84%) resolved. Of these, 2,273 targeted healthcare facilities, 1,232 involved HMOs, and two were against enrollees. Key issues included medicine unavailability, service denials, out-of-pocket payments for covered services, and delays in HMO referral authorizations.
Sanctions included 84 warnings to healthcare facilities, with 54 enrollees refunded N4,375,500 by 39 facilities. Four facilities faced suspension, six were delisted, and 35 HMOs received warnings, with 12 ordered to refund N748,200 to 15 enrollees. All complaints were investigated within 10 to 25 days, averaging 15 days for resolution.
NHIA Director-General Dr. Kelechi Ohiri emphasized that the sanctions aim to enhance accountability and quality care, supporting Nigeria’s Universal Health Coverage goals. A new policy mandates HMOs to issue referral codes within one hour, or facilities can proceed with treatment per protocol.
The NHIA’s actions reflect its commitment to transparency and improved healthcare services, aligning with President Bola Ahmed Tinubu’s vision. Complaints were received through multiple channels, including in-person, email, and the NHIA call centre, ensuring accessible grievance mechanisms for enrollees.
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