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

The National Health Insurance Authority (NHIA) has taken disciplinary action against 49 healthcare facilities and 47 Health Maintenance Organisations (HMOs) in 2024 for breaching operational standards, according to a statement issued Sunday.

Emmanuel Ononokpono, the Authority’s acting Director of Media and Public Relations, said the sanctions stemmed from findings in the NHIA’s 2024 Annual Complaints Report, compiled by the agency’s Enforcement Department under Acting Director Dr. Abdulhamid Habib Abdullahi.

Key complaints against healthcare providers included lack of essential medicines, denial of care, charging patients for services already covered by insurance, and failure to provide proper payment documentation. For HMOs, violations involved delays or refusals to issue referral authorisations, late settlement of reconciled payments, and negligence in monitoring quality at partner facilities.

In total, the NHIA handled 3,507 complaints during the year. Of these, 2,929 primarily against healthcare facilities were resolved, reflecting an 84% resolution rate. The breakdown shows 2,273 cases targeted HCFs, while 1,232 were directed at HMOs. Only two complaints were filed by providers against enrollees.

Based on the investigations:

Healthcare Facilities: 84 were issued formal warnings, 54 refunded ₦4.38 million to 54 enrollees, four were suspended, and six were completely delisted from the system.

Health Maintenance Organisations: 35 received warning letters and were instructed to implement corrective actions. 12 HMOs were directed to refund a combined ₦748,200 to 15 affected enrollees.

All complaints, the NHIA noted, were addressed within the standard 10–25 day response period, with an average resolution time of 15 days. When timelines could not be met, complainants were duly informed while investigations continued.

The authority affirmed that complaints were submitted through various channels including walk-ins, letters, email, phone calls, the NHIA call centre, and other official routes. Its Grievance Management Protocol ensures that every complaint is processed transparently and escalated as needed.

NHIA Director-General, Dr. Kelechi Ohiri, emphasized that the complaints mechanism plays a central role in driving accountability, improving care quality, and restoring public confidence.

“Enrollees deserve nothing less than top-tier care,” Ohiri said. “We are committed to holding providers and HMOs accountable. Sanctions are not just punitive they send a strong signal that we won’t compromise on service quality.”

He praised facilities delivering quality care and noted that with recent increases in capitation and fee-for-service payments—the first in over a decade—providers are better resourced and must deliver more, not less.

The NHIA has also introduced policy measures aimed at reducing delays in treatment. A new directive mandates that HMOs respond to referral code requests within one hour. If there’s no response, facilities are authorised to proceed with treatment under pre-established protocols.

According to Ohiri, the latest enforcement action underscores the NHIA’s dedication to transparency and fairness in Nigeria’s healthcare ecosystem. He reaffirmed the agency’s alignment with President Bola Ahmed Tinubu’s agenda to make Universal Health Coverage (UHC) a nationwide reality.