By DAYO ADESULU
The NHIA sanctions healthcare facilities and HMOs across Nigeria in 2024 after handling 3,507 complaints on service denial, out-of-pocket payments, and referral code delays. See the breakdown and implications.
🏥 NHIA Sanctions Healthcare Facilities and HMOs Over Poor Service Delivery in 2024
In a major crackdown to improve healthcare service quality in Nigeria, the National Health Insurance Authority (NHIA) announced the sanctioning of 49 healthcare facilities (HCFs) and 47 Health Maintenance Organisations (HMOs) in 2024 for violating operational guidelines.
The decision followed the release of the 2024 Annual Complaints Report compiled by the NHIA’s Enforcement Department, which handled 3,507 complaints from enrollees and providers nationwide.
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📋 Key Infractions: Why NHIA Sanctioned HCFs and HMOs
According to a statement by NHIA’s acting Director of Media and Public Relations, Emmanuel Ononokpono, the complaints involved major service failures:
❌ Common Violations by Healthcare Facilities (HCFs):
- Denial of covered medical services
- Out-of-pocket billing for insured treatments
- Poor medicine availability
- Lack of payment documentation
❌ Violations by Health Maintenance Organisations (HMOs):
- Delays in referral code issuance
- Non-payment or delayed payment to HCFs
- Failure to monitor quality assurance
- Poor communication with enrollees
📊 Complaint and Sanctions Summary
| Category | Number |
|---|---|
| Total Complaints | 3,507 |
| Resolved Complaints | 2,929 (84%) |
| Complaints vs HCFs | 2,273 |
| Complaints vs HMOs | 1,232 |
| Complaints vs Enrollees | 2 |
🚫 Breakdown of Sanctions Imposed
📌 On Healthcare Facilities (HCFs):
- 84 Formal Warnings
- N4.375 million refunded to 54 enrollees
- 4 Suspensions
- 6 Delistings
📌 On HMOs:
- 35 Formal Warnings
- ₦748,200 refunded to 15 enrollees
- Mandatory Corrective Actions
These sanctions were based on investigations completed within an average of 15 days, maintaining an 84% resolution rate within the NHIA’s target window of 10 to 25 days.
📞 NHIA’s Complaint Resolution Process
NHIA offers a structured, multi-channel complaint management system. Complaints were submitted through:
- In-person visits
- Letters
- Emails
- Telephone calls
- NHIA call center
Their Complaint and Grievance Management Protocol ensures timely response and escalation of complex cases when necessary.
🗣️ DG Ohiri Speaks: Accountability, Not Excuses
Speaking on the report, Dr. Kelechi Ohiri, NHIA Director-General, emphasized the agency’s stance:
“The sanctions are a clear message: the NHIA will not tolerate substandard service for enrollees. They deserve the best care, and we’ll ensure they get it.”
Ohiri also highlighted that with the first capitation and fee-for-service increases in 12 years, healthcare providers are now better funded and must do more, not less.
He added that effective service delivery will increase trust and enrolment, a key goal of the NHIA on the path to achieving Universal Health Coverage (UHC).
🕐 New Policy Alert: Referral Code Limit Mandated
To reduce treatment delays, NHIA has issued a policy circular limiting referral code issuance to one hour. If no response is received from HMOs within that time, HCFs are authorized to initiate treatment using emergency protocols.
This move aims to eliminate bureaucratic bottlenecks that delay critical care.
🧭 NHIA’s Vision: UHC and Transparent Healthcare Governance
The NHIA sanctions healthcare facilities and HMOs in line with its commitment to:
- Improving healthcare quality
- Enforcing accountability
- Protecting enrollees’ rights
- Providing fair and equitable service access
“The report demonstrates the Authority’s commitment to transparency, accountability, and continuous improvement,” the statement read.
❓FAQs: NHIA Sanctions Healthcare Facilities and HMOs
1. Why did NHIA sanction so many facilities and HMOs in 2024? Due to complaints of poor service delivery, out-of-pocket billing, and operational violations.
2. How many complaints were resolved? 84% of the 3,507 complaints were resolved within 10–25 days.
3. What actions did NHIA take against the violators? Formal warnings, suspensions, delistings, and enforced refunds to enrollees.
4. How can I file a complaint to NHIA? Through their call center, email, in-person visit, or written letter.
5. What happens if referral codes are delayed? Under new policy, HCFs must proceed with treatment after 1 hour without a code.
6. Will there be follow-up monitoring? Yes. HMOs and HCFs under sanction must implement corrective actions and may face further penalties if non-compliant.
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🔗 Related Resource
📘 Visit NHIA Official Website for more details and updates
