The National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities (HCFs) and 47 Health Maintenance Organisations (HMOs) in 2024 for various breaches of operational guidelines, the agency announced on Sunday.
In a statement signed by the authority’s Acting Director of Media and Public Relations, Emmanuel Ononokpono, the NHIA highlighted numerous complaints from enrollees, including unavailability of medicines, denial of services, out-of-pocket charges for covered treatments, and a lack of payment narrations by healthcare providers.
For the HMOs, common violations included delays or refusals in issuing referral authorisation codes, failure to settle agreed payments promptly, and neglect in monitoring quality assurance across facilities.
“These are some of the highlights of the 2024 Annual Complaints Report produced by the Enforcement Department of the NHIA under Acting Director, Enforcement, Dr Abdulhamid Habib Abdullahi,” the statement read.
The report, issued in accordance with the NHIA Act 17 of 2022, mandates the authority to establish a system for receiving and resolving complaints by scheme members and healthcare providers.
According to the NHIA, a total of 3,507 complaints were processed during the period. Of these, 2,929 (84%)—the majority of which were lodged against healthcare facilities—were resolved within the agency’s standard response timeframe of 10 to 25 days.
A breakdown of the complaints shows that 2,273 were against HCFs, 1,232 against HMOs, and only two against enrollees.
As part of its enforcement actions:
84 formal warnings were issued to healthcare facilities,
39 HCFs refunded ₦4,375,500 to 54 enrollees,
Four HCFs were suspended, and six were delisted from the scheme.
Regarding the HMOs:
35 received warning letters with directives for corrective action,
12 were ordered to refund ₦748,200 to 15 affected enrollees.
“All complaints received in 2024 were investigated and responded to within the average resolution time of 15 days,” the report noted.
“Where issues could not be resolved within the timeline, explanations were provided to the complainants while resolution efforts continued.”
Complaints were received through multiple channels, including in-person visits, written letters, email, telephone, the NHIA call centre, and other digital platforms. The NHIA’s Complaint and Grievance Management Protocol outlines clear procedures and escalation routes for complex or unresolved issues.
Speaking on the enforcement drive, NHIA Director-General Dr Kelechi Ohiri described the complaints resolution process as central to the agency’s broader mission to enhance accountability, rebuild trust, and improve healthcare quality across the country.
“Enrollees deserve the best care, and we will continue to do our best to ensure they get it,” Ohiri said. “The sanctions are meant to send a clear message that the NHIA will not tolerate substandard service for enrollees. We commend providers who are delivering high-quality services—they are worthy partners in our collective journey towards Universal Health Coverage (UHC).”
Ohiri also noted the recent increase in capitation and fee-for-service payments—the first in 12 years—as a critical investment in quality care delivery.
“With these enhanced payments, we expect more to be done for patients, not less. We must continue to work together to reduce delays in receiving care,” he added.
To further streamline healthcare delivery, the NHIA has issued a circular mandating that referral codes be provided within one hour. “If HCFs do not get a response from HMOs within one hour for enrolled patients, they should commence treatment based on an established protocol for such situations,” the statement said.
The NHIA emphasized that these reforms demonstrate its ongoing commitment to transparency, accountability, and continuous improvement in the national healthcare system. “This is in furtherance of the vision of President Bola Ahmed Tinubu to make Universal Health Coverage a reality for all Nigerians,” it concluded.
