The National Health Insurance Authority (NHIA) has commenced unannounced compliance checks at hospitals across the Federal Capital Territory (FCT) to enforce its new referral policy aimed at improving service delivery under the national health insurance scheme.
The policy mandates health maintenance organisations (HMOs) to issue pre-authorisation codes within one hour of receiving a treatment request from healthcare providers. This move is part of a broader strategy by the NHIA to eliminate delays that have long plagued access to timely care for insured patients.
The on-the-spot enforcement exercise, which took place over the weekend in Abuja, was led by the NHIA’s enforcement team. According to NHIA director-general, Dr. Kelechi Ohiri the directive ensures that healthcare providers may proceed with treatment if an HMO fails to issue the authorisation code within the stipulated time.
During surprise visits to National Hospital Abuja and the Federal Medical Centre (FMC), Jabi, the NHIA team assessed levels of compliance with the policy. At National Hospital, NHIA’s acting director of enforcement, Dr. Habib Abdulhamid, reported a 70 per cent compliance rate. However, he pointed out that some personnel were not fully aware of the policy details, prompting the team to conduct immediate sensitisation sessions.
“Some HMOs found to have delayed authorisations were contacted during the visit,” Abdulhamid stated. He stressed that NHIA will investigate all non-compliance cases and warned of sanctions for HMOs or facilities that fail to meet the policy’s expectations.
“We will not hesitate to take disciplinary actions against any non-compliant entity. Continuous improvement in response times and patient care is non-negotiable,” he emphasised.
At the National Hospital, NHIA desk officer, Tony Osuji noted that steps were already being taken to reduce waiting times and eliminate service bottlenecks for enrollees.
Meanwhile, at FMC Jabi, the NHIA team observed full compliance from HMOs. However, in one case, a delay in care was traced to the hospital’s failure to upload necessary patient data, despite prompt HMO response.
NHIA director for the north-central ‘B’ region, Dr. Chris Okoh commended the progress but emphasised the need for sustained vigilance and consistent policy adherence.
NHIA has announced plans to extend these compliance checks to other regions nationwide in the coming weeks as part of its drive to improve accountability, strengthen the health insurance system and enhance the patient experience for Nigerians.
