NHIA Sanctions 49 Health Facilities, 47 HMOs Over Widespread Service Breaches

The National Health Insurance Authority (NHIA) has announced sanctions against 49 healthcare facilities and 47 Health Maintenance Organizations (HMOs) across Nigeria for various breaches of its operational guidelines. The punitive actions, revealed on Monday, June 30, 2025, follow extensive investigations into thousands of complaints received from enrollees of both state and national health insurance schemes throughout 2024.

According to the NHIA’s 2024 Annual Complaints Report, compiled by the Enforcement Department under Acting Director Dr. Abdulhamid Habib Abdullahi, a total of 3,507 complaints were received during the year. Of these, 2,929 cases, representing 84 percent, were successfully resolved, with the majority directed against healthcare facilities.

Key issues identified in complaints against healthcare facilities (HCFs) included:

• Unavailability of essential medicines.
• Denial of services to enrollees.
• Demanding out-of-pocket payments for services that are covered by insurance.
• Non-provision of proper payment narrations for services rendered.

For HMOs, the breaches primarily involved:

• Delays or outright denials of referral authorization codes.
• Delays in the settlement of agreed reconciled payments to healthcare providers.
• Refusal or failure to monitor quality assurance in facilities under their purview.

The sanctions imposed by the NHIA varied depending on the severity of the infraction. These measures include:

• Issuance of 84 formal warnings to healthcare facilities.
• Enforcing refunds totaling N4,375,500 to 54 enrollees from 39 healthcare facilities.
• Suspending four healthcare facilities.
• Delisting six healthcare facilities for repeated violations.
• Issuing warning letters and directives for corrective actions to 35 HMOs.
• Mandating 12 HMOs to refund a total of N748,200 to 15 enrollees.

NHIA Director-General, Dr. Kelechi Ohiri, emphasized that these sanctions are part of the agency’s renewed commitment to enhancing accountability, rebuilding public trust, and ensuring that enrollees receive the quality of care they deserve.

“Enrollees deserve the best care, and we will continue to ensure they get it,” Dr. Ohiri stated. “These sanctions send a clear message that the NHIA will not tolerate substandard service.” He also highlighted that with the recent increase in provider payments – the first in 12 years – patients should expect improved, not diminished, service quality.

As part of ongoing reforms, the NHIA has also introduced a new policy mandating that referral authorization codes must be issued by HMOs within one hour. In cases where HMOs fail to respond within this timeframe, healthcare facilities are now directed to proceed with treatment based on established protocols. The NHIA’s report underscored its dedication to transparency, fair enforcement, and continuous improvement in healthcare service provision, aligning with President Bola Tinubu’s vision for achieving Universal Health Coverage (UHC) in Nigeria.