Abuja: The National Health Insurance Authority (NHIA) has taken significant disciplinary action against 49 healthcare facilities and 47 Health Maintenance Organisations in 2024 for breaching operational guidelines. This move is part of an effort to uphold service standards and protect enrollees under Nigeria’s health insurance schemes.
According to News Agency of Nigeria, Mr Emmanuel Ononokpono, Acting Head of the Media and Public Relations Unit at NHIA, disclosed the sanctions in a statement issued in Abuja. The measures are based on findings from the 2024 Annual Complaints Report released by the NHIA’s Enforcement Department, revealing that 2,929 out of 3,507 complaints from enrollees were resolved during the period.
The Acting Director of Enforcement, Dr Abdulhamid Habib Abdullahi, stated that most complaints revolved around denial of services, non-availability of essential drugs, illegal out-of-pocket charges, and delays in referral authorisation. The NHIA responded by issuing formal warnings, enforcing refunds to patients, suspensions, and delisting for the erring parties. Specifically, N4.37 million was refunded to 54 enrollees by 39 healthcare facilities, while 12 HMOs refunded N748,200 to 15 enrollees. Additionally, four healthcare facilities were suspended, and six were delisted due to repeated violations. The NHIA also issued 84 formal warnings to healthcare providers and required 35 HMOs to implement corrective actions.
Dr Kelechi Ohiri, NHIA Director-General, stressed that these sanctions are part of ongoing efforts to strengthen accountability, restore public confidence, and increase enrolment in the national health insurance scheme. He emphasized that enrollees deserve high-quality care and that the NHIA will not tolerate substandard service. Dr Ohiri also praised providers consistently delivering quality care, noting that recent increases in provider payments should lead to improved services.
As part of continuing reforms, Dr Ohiri announced that referral authorisation codes must now be issued within one hour. In cases of delay, healthcare facilities may proceed with treatment based on approved protocols. Complaints were submitted through various channels, including call centres, email, and walk-in visits, with the NHIA maintaining an average response time of 15 days per case, within its resolution window of 10 to 25 days.
Dr Ohiri concluded by stating that the report reflects the NHIA’s commitment to transparency, fair enforcement, and quality healthcare, aligning with President Bola Tinubu’s Universal Health Coverage agenda.
