In a decisive move to improve the quality of healthcare services for enrollees, the National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities (HCFs) and 47 Health Maintenance Organisations (HMOs) over various infractions in 2024, following investigations into 3,507 complaints received across the country.
The NHIA’s 2024 Annual Complaints Report, released by the Enforcement Department and led by Acting Director Dr Abdulhamid Habib Abdullahi, reveals that 2,929 complaints, representing 84% of the total were successfully resolved.
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In a statement by Ag. Dir Media and PR, Emmanuel Ononokpono, most complaints were directed at healthcare facilities for issues such as denial of service, unavailability of medicines, and unauthorized out-of-pocket payments for services meant to be covered.
In contrast, complaints against HMOs mainly involved delays in issuing referral authorization codes, untimely reconciliation of payments, and poor oversight of healthcare facilities.
In response, NHIA issued 84 warning letters to healthcare providers, suspended four facilities, and delisted six others.
“Additionally, 54 enrollees received a total refund of ₦4,375,500 from 39 facilities. On the HMO side, 35 companies received warning letters and 12 were mandated to refund ₦748,200 to 15 enrollees”.
NHIA also emphasized timeliness in handling complaints, achieving an average resolution time of 15 days, with all cases investigated within the standard 10 to 25-day window.
The Authority highlighted that complaints were submitted through multiple channels, including in-person, email, telephone, and the NHIA call center.
The Director-General NHIA, Dr Kelechi Ohiri, said the sanctions reflect the agency’s commitment to enforcing accountability and ensuring enrollees receive the quality of care they deserve
“Enrollees deserve the best care, and we will continue to ensure 9they get it,” Ohiri said. “We commend the diligent providers and expect even more, especially with the recent increases in capitation and service fees.”
To further strengthen patient protection, NHIA has introduced a policy limiting the issuance time for referral codes to one hour. If providers do not receive timely authorization from HMOs, they are directed to proceed with treatment under established protocols.
The report underscores NHIA’s commitment to transparency, continuous service improvement, and advancing the vision of President Bola Tinubu for achieving Universal Health C
overage (UHC) in Nigeria.