Lucky Obukohwo Reporting
The National Health Insurance Authority (NHIA), said it wielded its sledge hammer on 49 healthcare facilities and 47 Health Maintenance Organisations in 2024.
It said the sanctions were due to the violations of its operational guidelines.
This was revealed in a statement signed by its acting Director of Media and Public Relations, Emmanuel Ononokpono and made available to Journalists.
The statement listed major 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.
It was said for the HMOs, NHIA 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 maintained further 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.