The National Health Insurance Authority (NHIA) has penalised 49 healthcare facilities and 47 Health Maintenance Organisations (HMOs) in 2024 for breaching its operational guidelines.

In a statement released on Sunday by the Acting Director of Media and Public Relations, Emmanuel Ononokpono, the NHIA revealed that common complaints against healthcare facilities included drug unavailability, denial of services, out-of-pocket payments for services meant to be covered, and failure to provide payment details.

For the HMOs, issues ranged from delays or refusal to issue referral authorisation codes, slow payment settlements, to neglecting facility quality assurance checks.

“These findings are outlined in the NHIA’s 2024 Annual Complaints Report, prepared by the Enforcement Department under Acting Director Dr Abdulhamid Habib Abdullahi,” the statement said.

The report was issued in line with the NHIA Act 17 of 2022, which mandates the agency to establish mechanisms for resolving complaints from enrollees and healthcare providers.

In total, the NHIA handled 3,507 complaints in 2024, resolving 2,929 cases—84 per cent of them—mostly concerning healthcare facilities. The breakdown includes 2,273 complaints against healthcare providers and 1,232 against HMOs. Only two complaints were filed by providers against enrollees.

Disciplinary actions were taken based on the findings. The NHIA issued 84 formal warnings to healthcare providers, suspended four facilities, and delisted six others. Additionally, 54 enrollees received a total refund of ₦4.38 million from 39 healthcare providers.

Among the HMOs, 35 received warning letters and were ordered to implement corrective measures, while 12 were directed to refund ₦748,200 to 15 enrollees.

The report further disclosed that all complaints were investigated and addressed within the standard response timeframe of 10 to 25 days, with an average resolution time of 15 days. The agency maintained an 84% resolution rate within this timeline.

Complaints reached the NHIA through various channels, including walk-ins, written submissions, emails, telephone calls, and its call centre. The agency emphasised its established complaint and grievance protocol, which outlines proper complaint handling and escalation procedures.

Commenting on the report, NHIA Director General, Dr Kelechi Ohiri, stressed the importance of accountability in improving healthcare quality and building public trust. He noted that the sanctions are intended to reinforce the NHIA’s commitment to better service delivery.

“Enrollees deserve quality care, and we are committed to ensuring they receive it,” Ohiri said. “With the recent increase in capitation and service fees—the first in 12 years—we expect providers to deliver more, not less.”

He also announced new policy measures, including a mandate that HMOs respond to referral code requests within one hour. If no response is received, healthcare providers are authorised to proceed with treatment using established protocols.

Ohiri concluded by stating that the report demonstrates NHIA’s dedication to transparency, fairness, and continuous improvement, aligning with President Bola Tinubu’s goal of achieving Universal Health Coverage (UHC) for all Nigerians.