NHIA Sanctions 96 Health Institutions and HMOs in 2024 Over Service Failures

ABUJA – In a firm move to enhance healthcare service delivery and accountability, the National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities (HCFs) and 47 Health Maintenance Organisations (HMOs) in 2024, following investigations into thousands of complaints from enrolled patients across Nigeria.

The enforcement, part of NHIA’s renewed strategy to improve healthcare quality under the National and State Health Insurance Schemes, was disclosed in a statement signed by the Acting Director of Media and Public Relations, Emmanuel Ononokpono.

The sanctions were based on findings contained in the 2024 Annual Complaints Report, compiled by the NHIA Enforcement Department under the Acting Director, Dr Abdulhamid Habib Abdullahi. The report is mandated by Section 17 of the NHIA Act of 2022, which requires the Authority to establish effective mechanisms for addressing grievances from enrollees and stakeholders.

High Volume of Complaints Resolved, Refunds Issued

According to the report, the NHIA processed a total of 3,507 complaints in 2024. A staggering 84 percent — 2,929 cases — were resolved within the year, showcasing a proactive approach to addressing patient dissatisfaction and systemic issues.

The vast majority of grievances — 2,273 cases — were directed at healthcare facilities. These complaints ranged from unavailability of essential medications to denial of care, unwarranted out-of-pocket charges for covered services, and failure to provide transparent payment documentation.

Meanwhile, 1,232 complaints were lodged against HMOs. The main grievances included delays in providing referral authorization codes, late settlement of reconciled payments, and failure to conduct regular quality assurance checks at partner facilities.

Impressively, the NHIA ensured that all complaints requiring investigation were handled within the agency’s standard response time of 10 to 25 days. The average resolution time was 15 days, with complainants receiving updates in cases where issues extended beyond this timeframe.

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Sanctions and Financial Redress for Enrollees

The NHIA did not hesitate to impose penalties based on the findings. Among the 49 healthcare facilities sanctioned, 84 formal warnings were issued. Furthermore, 54 enrollees received financial refunds totaling ₦4,375,500 from 39 different healthcare providers. Additionally, four healthcare facilities were suspended while six others were completely delisted from the NHIA program.

On the HMO side, 35 organisations received official warning letters with directives for immediate corrective actions. Another 12 HMOs were directed to refund ₦748,200 to 15 affected enrollees. The NHIA emphasized that these measures are designed to uphold quality standards and reinforce accountability within the health insurance ecosystem.

New Policies to Fast-Track Patient Care

In a bid to reduce treatment delays, the NHIA has introduced a new policy mandating that referral codes must be issued within one hour. Should a healthcare facility fail to receive a timely response from an HMO, they are permitted to proceed with patient treatment under pre-established emergency protocols.

The policy shift is a response to common complaints regarding delays in service due to slow authorization processes and reflects the NHIA’s commitment to a patient-first approach.

Driving Accountability and Trust in Healthcare

Commenting on the developments, NHIA Director-General Dr Kelechi Ohiri reiterated the agency’s resolve to promote transparency, rebuild trust, and enhance quality of care for all enrollees. “Enrollees deserve the best care, and we will continue to do our best to ensure they get it,” Ohiri stated.

He further commended healthcare providers who consistently deliver high-quality services, highlighting that these partners play a crucial role in Nigeria’s journey toward Universal Health Coverage (UHC). “With the recent actuarial review leading to increased capitation and fee-for-service rates — the first in 12 years — we expect healthcare providers to improve service delivery, not decline,” he added.

The NHIA’s complaint management structure is anchored on a detailed grievance protocol that outlines response timelines, escalation procedures for complex cases, and multiple channels for submitting complaints, including in-person visits, written communication, emails, telephone, and the NHIA call center.

A Step Forward in Nigeria’s Healthcare Reform

The sanctions and corresponding policy enhancements signal a significant step toward reshaping Nigeria’s health insurance framework to serve citizens better. By cracking down on poor service delivery and fostering operational transparency, the NHIA is working to create a fair and efficient healthcare system.

These developments align with President Bola Tinubu’s broader vision to make Universal Health Coverage a reality for all Nigerians, as part of his administration’s social investment and healthcare reform agenda.