The National Health Insurance Authority, NHIA, has disclosed that 49 healthcare facilities and 47 Health Maintenance Organisations were sanctioned in 2024 over violations of its operational guidelines.
The agency made this known in a statement on Sunday by its acting Director of Media and Public Relations, Emmanuel Ononokpono.
PUNCH ONLINE reports that the statement listed key issues recorded in the complaints against HCFs to include unavailability of medicines, denial of services, out-of-pocket payment for covered services, and non-provision of payment narrations.
For the HMOs, the National Health Insurance Agency said the issues were related to delays or denials of referral authorisation codes, delays in settlement of agreed reconciled payments, and refusal to monitor quality assurance in facilities, among others.
It further said that 35 HMOs received formal warnings, while 12 were directed to refund the sum of N748,200 to 15 enrollees.
According to the report, in 2024, all complaints were fully investigated and responded to within the standard response time of 10 to 25 days.
Speaking on the development, the Director General of NHIA, Dr Kelechi Ohiri, described the NHIA’s complaints management process as organic to the agency’s efforts to promote accountability, rebuild trust and improve quality of care.
The Director General expressed the believe that it will ultimately drive higher enrolment by encouraging providers to offer current enrollees an enhanced quality of service.
The authority added that it has also put additional policies in place beyond the sanctions and issued a circular mandating a limit of one hour for the issuance of referral codes for treatment.
