NHIA Sanctions 49 Healthcare Facilities and 47 Health Maintenance Organisations Over Infractions

Strategic Insights -

In a major crackdown on subpar healthcare services, the National Health Insurance Authority (NHIA) has taken decisive action against 49 healthcare facilities (HCFs) and 47 Health Maintenance Organisations (HMOs) in 2024. The sanctions, announced in the NHIA's 2024 Annual Complaints Report, follow an investigation into 3,507 complaints received across the country. The report highlights the NHIA's commitment to enforcing accountability and ensuring enrollees receive the quality of care they deserve.

Key Takeaways:

  • The NHIA sanctioned 49 HCFs and 47 HMOs over various infractions in 2024, including denial of service, unavailability of medicines, and unauthorized out-of-pocket payments for services meant to be covered.
  • The most common complaints against HCFs involved issues such as denial of service, unavailability of medicines, and unauthorized out-of-pocket payments for services meant to be covered.
  • Complaints against HMOs mainly involved delays in issuing referral authorization codes, untimely reconciliation of payments, and poor oversight of healthcare facilities.
  • In response, NHIA issued 84 warning letters to healthcare providers, suspended four facilities, and delisted six others.
  • Enrollees received a total refund of ₦4,375,500 from 39 facilities, while HMOs were mandated to refund ₦748,200 to 15 enrollees.
  • The NHIA achieved an average resolution time of 15 days for complaints, with all cases investigated within the standard 10 to 25-day window.

Statistics:

  • 3,507 complaints were received across the country in 2024.
  • 2,929 complaints, representing 84% of the total, were successfully resolved.
  • 4,375,500 (political currency symbol ₦ for Nigerian naira) (or 4 million, 375 thousand, five hundred naira) refund was made to enrollees from 39 facilities.
  • 748,200 (political currency symbol ₦ for Nigerian naira) (or seven hundred and forty-eight thousand, two hundred and naira) refund was mandated to 15 enrollees from HMOs.
  • The NHIA issued 84 warning letters to healthcare providers.

Sources:

  • Voice of Nigeria: June 29, 2025 - available online