ABUJA — In a bold move to reinforce its commitment to improved healthcare delivery and accountability, the National Health Insurance Authority (NHIA) has taken disciplinary actions against a total of 96 healthcare players — comprising 49 healthcare facilities and 47 Health Maintenance Organisations (HMOs) — for various breaches of its operational guidelines in 2024.
The authority disclosed this in a statement released on Sunday and signed by its Acting Director of Media and Public Relations, Emmanuel Ononokpono. According to the statement, the sanctions were part of the findings from the NHIA’s 2024 Annual Complaints Report, compiled by the Enforcement Department under the leadership of the Acting Director of Enforcement, Dr Abdulhamid Habib Abdullahi.
The infractions recorded against the affected healthcare facilities ranged from persistent unavailability of essential drugs, refusal to offer services covered under the scheme, compelling enrollees to pay out-of-pocket for services already paid for under the health insurance scheme, to failure in providing adequate payment narrations for rendered services.
For the sanctioned HMOs, the report cited delays or outright denials in the issuance of referral authorization codes, prolonged settlement timelines of agreed payments, and a general neglect of their duty to monitor quality assurance in the facilities under their supervision. These lapses, according to the NHIA, directly impacted service delivery to enrollees and compromised the agency’s goals of quality and accessible healthcare.
The statement revealed that a total of 3,507 complaints were formally lodged in the 2024 operational year, out of which 2,929 cases — about 84 percent — were resolved. A closer breakdown of the complaints showed that 2,273 were lodged against healthcare facilities, 1,232 were filed against HMOs, while only two complaints were raised against enrollees themselves by service providers.
As part of the disciplinary measures taken, 84 formal warnings were issued to erring healthcare facilities. Additionally, 54 enrollees received refunds totalling N4,375,500 from 39 healthcare providers found guilty of exploiting patients financially. Four facilities were suspended from operations, while six others were delisted entirely from the NHIA programme for repeated violations and failure to adhere to minimum service standards.
The NHIA also sanctioned 35 HMOs with official warning letters and directed them to institute corrective measures immediately. Furthermore, 12 of the HMOs were compelled to refund a total of N748,200 to 15 affected enrollees, who had either been denied rightful care or made to pay for services already covered under the scheme.
In line with the NHIA’s standard operational procedure, all complaints received in 2024 were investigated and responded to within the stipulated 10 to 25 working days. The average resolution time for cases requiring investigation stood at 15 days, with an overall resolution success rate of 84 percent. For cases that extended beyond the timeframe, the NHIA stated that complainants were duly informed while follow-up actions continued until final closure was achieved.
The report further outlined the multiple channels through which complaints were submitted during the year, including in-person visits, official letters, emails, telephone calls, the NHIA call centre, and other recognized communication platforms.
To ensure consistency and fairness in its complaint management process, the Authority highlighted the implementation of a formal Complaint and Grievance Management Protocol. This framework establishes clear timelines, escalation procedures for complex cases, and transparency measures to ensure the system remains responsive to the needs of stakeholders.
Commenting on the development, the Director General of NHIA, Dr Kelechi Ohiri, emphasized that the agency’s complaint management strategy is integral to its broader agenda of building public trust, improving service quality, and ultimately boosting enrolment under the health insurance scheme.
Dr Ohiri stressed that patients enrolled under NHIA deserve nothing short of quality care, reiterating that the recent enforcement actions serve as a stern warning to all service providers. He also acknowledged the facilities that have remained committed to excellence, stating that such providers are valuable allies in the pursuit of Universal Health Coverage (UHC) for Nigerians.
“We commend providers who are consistently delivering excellent care. They are true partners in our collective journey towards achieving UHC. With the recent actuarial adjustments leading to increased capitation and fee-for-service payments, the first such review in over a decade, we expect higher performance, not less,” Ohiri said.
In addition to sanctions, the NHIA disclosed that further policy steps have been taken to enhance service delivery. One of such measures includes a new directive mandating that referral authorization codes must be issued by HMOs within one hour. Where HMOs fail to respond within the stipulated time, healthcare providers have been authorized to proceed with treatment based on approved emergency protocols.
The NHIA maintained that these efforts are aligned with President Bola Ahmed Tinubu’s vision to strengthen the nation’s health system and make Universal Health Coverage a tangible reality for every Nigerian. According to the agency, the 2024 report is a testament to its resolve to promote accountability, fairness, and continuous improvement within Nigeria’s health insurance ecosystem.
