The National Health Insurance Authority has sanctioned 49 healthcare facilities and 47 Health Maintenance Organisations in 2024 over violations of its operational guidelines, the agency said on Sunday.
A statement on Sunday signed by the authority’s acting Director of Media and Public Relations, Emmanuel Ononokpono, noted that the key issues recorded in the complaints against HCFs were unavailability of medicines, denial of services, out-of-pocket payment for covered services and non-provision of payment narrations.
For the HMOs, it said the issues were related to delays or denials of referral authorisation codes, delays in settlement of agreed reconciled payments, refusal to monitor quality assurance in facilities, etc.
The statement read, “These are some of the highlights of the 2024 Annual Complaints Report produced by the Enforcement Department of the NHIA under Acting Director, Enforcement, Dr Abdulhamid Habib Abdullahi.
“The Report was issued in compliance with the NHIA Act 17 of 2022, which requires NHIA to establish mechanisms for receiving and resolving complaints by members of the Schemes and Health Care Facilities.
“In all, a total of 3507 complaints were handled during the period, out of which 2929 complaints (84 per cent), majority of which were against HCFs, were resolved.
“A breakdown of the distribution of complaints reveals that 2273 were reports against HCFs, 1232 were against HMOs. Only two reports were recorded against enrollees by providers.”
It added that 35 HMOs received formal warnings, while 12 were directed to refund N748,200 to 15 enrollees.
“Based on the outcome of investigations, various sanctions were imposed on erring healthcare providers where indicated. Eighty-Four (84) formal warnings were issued to HCFs, while 54 enrollees received refunds of N4,375,500 from 39 HCFs.
“Four HCFs were suspended and six others were delisted. Also, 35 HMOs got warning letters and directives to institute corrective actions while 12 HMOs were directed to refund a total of N748,200 to 15 enrollees,” the statement added.
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