The National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities and 47 Health Maintenance Organisations (HMOs) in 2024 for violating operational standards under Nigeria’s health insurance scheme.
The move comes as part of efforts to improve service delivery, protect enrollees and reinforce accountability within the system.
According to a statement issued by NHIA’s acting head of media and public relations, Emmanuel Ononokpono in Abuja on Sunday, the sanctions followed the resolution of 2,929 complaints from 3,507 received nationwide, as captured in the agency’s 2024 Annual Complaints Report compiled by its enforcement department. The bulk of the complaints were filed by patients who reported being denied services, made to pay out-of-pocket for treatments covered by insurance, or faced delays in obtaining referral authorisations. Others highlighted the lack of essential medicines at approved facilities.
In response, the NHIA imposed a range of penalties, including formal warnings, enforced refunds to patients, temporary suspensions and permanent delisting of repeat offenders. A total of ₦4.37 million was refunded by 39 healthcare facilities to 54 aggrieved enrollees, while 12 HMOs paid back ₦748,200 to 15 enrollees. Four healthcare providers were suspended and six were delisted entirely for repeated violations of NHIA protocols. An additional 84 providers received formal warnings and 35 HMOs were instructed to implement corrective measures.
The NHIA’s acting director of enforcement, Dr Abdulhamid Abdullahi explained that the actions taken reflect the agency’s growing focus on compliance and fairness. He added that complaints were submitted via the call centre, email, and physical walk-in channels and the authority maintained an average case resolution time of 15 days, in line with its 10–25-day resolution window.
Director-general of NHIA, Dr. Kelechi Ohiri reaffirmed the agency’s resolve to improve the experience of enrollees and restore public confidence in the health insurance scheme. He said enrollees must be able to access the services they are entitled to without barriers and that substandard care would not be tolerated. He also acknowledged healthcare providers who have consistently delivered high-quality service and stated that with the recent upward adjustment in provider payment rates – the first in 12 years – patients should now expect improved care.
Among other reforms, the NHIA has mandated that referral authorisation codes must be issued within an hour, failing which treatment can proceed under established clinical protocols.
