National Health Insurance Authority (NHIA) has penalised a total of 96 organisations, including 49 healthcare facilities (HCFs) and 47 Health Maintenance Organisations (HMOs), over violations of its operational guidelines in 2024.
This was disclosed in a statement issued on Sunday by the Authority’s Acting Director of Media and Public Relations, Emmanuel Ononokpono. The sanctions stemmed from findings in the NHIA’s 2024 Annual Complaints Report, compiled by its Enforcement Department under Acting Director, Dr Abdulhamid Habib Abdullahi.
According to the NHIA, complaints against healthcare providers primarily involved denial of service, unavailability of medicines, illegal out-of-pocket payments for covered services, and failure to provide payment narrations. On the other hand, HMOs were found wanting for delays or outright denial of referral authorisation codes, failure to settle reconciled payments promptly, and neglect in quality assurance monitoring of healthcare facilities.
“In total, 3,507 complaints were received and handled during the year. Of these, 2,929 representing 84% were resolved,” the statement said.
The report showed that most complaints (2,273) were filed against healthcare facilities, while 1,232 were lodged against HMOs. Only two complaints were made against enrollees.
As a result of investigations, sanctions were imposed on erring organisations. For HCFs, 84 formal warnings were issued, with 54 enrollees refunded a total of N4,375,500 by 39 facilities. Four facilities were suspended, while six were delisted entirely from the NHIA programme.
For the HMOs, 35 were issued formal warnings and directed to implement corrective measures. Additionally, 12 were ordered to refund N748,200 to 15 enrollees.
The NHIA noted that all complaints were addressed within its standard response timeline of 10 to 25 days, with the average resolution time being 15 days.
Where issues could not be resolved within this timeframe, explanations were provided, and resolution efforts continued. Complaints were submitted via various channels, including in-person visits, email, telephone calls, the NHIA call centre, and formal letters.
The NHIA also reiterated its Complaint and Grievance Management Protocol, which ensures timely responses and outlines escalation procedures for complex cases.
Commenting on the report, NHIA Director General, Dr Kelechi Ohiri, said the agency remains committed to strengthening accountability, improving service quality, and rebuilding trust in the health insurance scheme.
“Enrollees deserve the best care, and we will not tolerate substandard services. The sanctions send a clear message to all stakeholders. At the same time, we commend providers delivering excellent care, they are vital to our journey toward Universal Health Coverage,” Ohiri stated.
He further noted that with the recent adjustment in capitation and fee-for-service payments, the first in 12 years, providers are now better positioned to improve service delivery.
In addition, the NHIA has issued new policy directives, including a circular mandating HMOs to provide referral authorisation codes within one hour. In cases of delay, HCFs are advised to proceed with treatment under predefined emergency protocols.
The NHIA said these efforts underscore its commitment to fairness, transparency, and achieving President Bola Ahmed Tinubu’s vision of Universal Health Coverage for all Nigerians.
