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 said the move was part of a decisive effort 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, said this in a statement on Sunday in Abuja.

He said the sanctions were based on findings from the 2024 Annual Complaints Report released by the NHIA’s Enforcement Department.

He added that a total of 2,929 out of 3,507 complaints from enrollees were resolved during the period.

According to the Acting Director of Enforcement, Dr Abdulhamid Habib Abdullahi, most 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.

“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 HCFs 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 actions,” Abdullahi said.

NHIA Director-General, Dr Kelechi Ohiri, said the sanctions were part of ongoing efforts 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 lauded providers who had consistently delivered quality care and highlighted that with the recent increase in provider payments, the first in 12 years, patients should expect better, not worse, service.

As part of ongoing reforms, Ohiri announced that referral authorisation codes must now be issued within one hour, and in cases of delay, HCFs might proceed with treatment based on approved protocols.

“Complaints were submitted through various channels, including call centres, email, and walk-in visits.

“The NHIA maintained an average response time of 15 days per case, well within its resolution window of 10 to 25 days.”

Ohiri added that the report reflected NHIA’s commitment to transparency, fair enforcement, and quality healthcare, in line with President Bola Tinubu’s Universal Health Coverage (UHC) agenda. (NAN)

Edited by Chinyere Nwachukwu/Abiemwense Moru