The National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities (HCFs) and 47 Health Maintenance Organisations (HMOs) in 2024 for various violations of operational guidelines.
The agency stated that the action is part of its efforts to uphold service standards and protect enrollees under Nigeria’s health insurance schemes.
Mr. Emmanuel Ononokpono, Acting Head of the Media and Public Relations Unit at NHIA, disclosed this in a statement issued on Sunday in Abuja.
He explained that the sanctions followed findings from the NHIA’s 2024 Annual Complaints Report, compiled by its Enforcement Department.
A total of 2,929 out of 3,507 enrollee complaints were resolved within the reporting period.
According to the Acting Director of Enforcement, Dr. Abdulhamid Habib Abdullahi, the majority of complaints were related to denial of services, non-availability of essential drugs, illegal out-of-pocket charges, and delays in referral authorisation.
“The NHIA sanctioned erring facilities and HMOs through formal warnings, enforced refunds to patients, suspensions, and delisting,” Abdullahi said.
In total, 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 for repeated violations.
The NHIA also issued 84 formal warnings to healthcare providers, and 35 HMOs were directed to implement corrective measures.
NHIA Director-General, Dr. Kelechi Ohiri, said the sanctions are part of broader reforms to strengthen accountability, restore public confidence, and increase enrolment in the national health insurance scheme.
“Enrollees deserve the best care, and we will continue to ensure they get it. These sanctions send a clear message that the NHIA will not tolerate substandard service,” Ohiri stated.
He praised providers that have consistently delivered quality care and noted that, following the recent increase in provider payments—the first in 12 years—patients should expect improved service.
As part of ongoing reforms, Dr. Ohiri announced that referral authorisation codes must now be issued within one hour. If delayed, healthcare providers may proceed with treatment based on approved clinical protocols.
Complaints, he added, were submitted through various channels, including call centres, email, and in-person visits.
The NHIA maintained an average response time of 15 days per case, staying within its resolution window of 10 to 25 days.
Dr. Ohiri concluded that the report reflects the NHIA’s commitment to transparency, fair enforcement, and quality healthcare, in line with President Bola Tinubu’s Universal Health Coverage (UHC) agenda.
