The NHIA sanctions healthcare providers including 49 healthcare facilities and 47 HMOs in 2024, a bold move enforcing accountability
[dropcap]T[/dropcap]he National Health Insurance Authority (NHIA) has sanctioned 49 healthcare facilities and 47 Health Maintenance Organisations (HMOs) in 2024.
Also read: SUNU Health strengthens provider collaboration nationwide
This action was taken over violations of its operational guidelines, the agency announced on Sunday.
This decisive move aims to ensure compliance and improve service quality across the national health insurance schemes, impacting many enrollees.
A statement issued on Sunday, signed by Emmanuel Ononokpono, the authority’s Acting Director of Media and Public Relations, detailed the infractions.
For healthcare facilities, key issues recorded in complaints included unavailability of medicines, denial of services, out-of-pocket payments for covered services, and non-provision of payment narrations. These problems directly affect patient care.
For the HMOs, the complaints primarily related to delays or denials of referral authorisation codes.
Other significant issues involved delays in the settlement of agreed reconciled payments and a refusal to monitor quality assurance in facilities.
Such failures disrupt the seamless provision of healthcare services to enrollees under the scheme.
The statement clarified that these findings were some of the highlights from the 2024 Annual Complaints Report.
This comprehensive report was produced by the Enforcement Department of the NHIA, led by Acting Director, Enforcement, Dr. Abdulhamid Habib Abdullahi.
The report provides a detailed overview of the challenges faced by enrollees and facilities within the system, informing the initiative.
The report’s issuance complies with the NHIA Act 17 of 2022. This Act mandates the NHIA to establish robust mechanisms for receiving and resolving complaints.
These complaints can originate from members of the schemes or from healthcare facilities themselves, ensuring a comprehensive feedback loop for accountability.
In total, the NHIA handled 3,507 complaints during the period. Out of these, a significant 2,929 complaints, representing 84 per cent of the total, were successfully resolved.
The majority of these resolved complaints were lodged against healthcare facilities, indicating where most service delivery issues originated, prompting the sanction.
A detailed breakdown of the distribution of these complaints further reveals the scale of the issues. There were 2,273 reports filed against healthcare facilities, and 1,232 reports were made against HMOs.
Notably, only two reports were recorded against enrollees by providers, underscoring that the majority of issues stemmed from service delivery shortcomings.
Based on the thorough outcome of investigations, various sanctions were imposed on erring healthcare providers where indicated.
A total of 84 formal warnings were issued to healthcare facilities, indicating a broad need for improved adherence to guidelines.
Additionally, 54 enrollees received refunds totalling N4,375,500 from 39 healthcare facilities, directly compensating them for previous overcharges.
More severe actions were also taken: four healthcare facilities were suspended, and six others were permanently delisted from the scheme.
Similarly, 35 HMOs received warning letters and specific directives to institute corrective actions.
Furthermore, 12 HMOs were directed to refund a total of N748,200 to 15 enrollees, reinforcing the NHIA’s commitment to financial restitution for affected patients.
According to the report, all complaints received in 2024 were fully investigated and responded to within the standard response time.
This timeframe is set between 10 to 25 days, demonstrating the agency’s efficiency.
The average complaint resolution time for complaints that required detailed investigation was consistently 15 days, reflecting a timely response system.
The complaints resolution rate, measured within the established timeline, reached an impressive 84 per cent.
Where issues could not be resolved within the primary timelines, an explanation was promptly provided to complainants, ensuring transparency while the resolution process continued until completion.
This commitment supports the NHIA Sanctions Healthcare Providers effort.
The complaints received in 2024 were submitted through various accessible routes.
These included in-person visits, formal written letters, email correspondence, telephone calls, and interactions through the dedicated NHIA call centre, along with other communication channels.
This multi-channel approach ensures broad accessibility for all stakeholders.
The NHIA Complaint and Grievance Management Protocol establishes clear policies and procedures for comprehensive complaint management.
It expressly provides that complaints must be responded to in a timely manner, upholding accountability.
It also outlines robust escalation procedures for handling complex or particularly serious complaints, ensuring no issue is left unresolved.
Speaking on these significant developments, Dr. Kelechi Ohiri, the NHIA Director-General, described the NHIA’s complaints management process as integral to the agency’s broader efforts.
These efforts aim to enhance accountability, meticulously rebuild public trust, and significantly improve the overall quality of care delivered across the health insurance schemes.
Dr. Ohiri firmly believes this systematic approach will ultimately drive higher enrolment by encouraging providers to consistently offer current enrollees an enhanced quality of service.
He stated, “Enrollees deserve the best care and we will continue to do our best to ensure they get it. The sanctions are meant to send a clear message that the NHIA will not tolerate substandard service for enrollees.”
This underscores the purpose of NHIA Sanctions Healthcare Providers.
He also commended providers who are consistently delivering high-quality services to enrollees, acknowledging them as worthy partners in the collective journey towards Universal Health Coverage (UHC).
Dr. Ohiri highlighted recent actuarially derived increases of capitation and fee-for-service payments to providers, noting these are the first such increases in 12 years.
“With these increases, we expect more to be done for patients, not less. We must continue to work together to reduce delays in receiving care,” he emphasised.
Beyond these sanctions, the authority has also implemented additional policies.
It has issued a circular mandating a strict limit of one hour for the issuance of referral codes for treatment.
This new policy is designed to eliminate unnecessary delays in accessing critical care, directly benefiting patients and streamlining processes.
The circular further stipulates that if healthcare facilities (HCFs) do not receive a response from HMOs within one hour for enrolled patients, they should commence treatment based on the established protocol to deal with such situations.
This empowers providers to prioritise patient care, reducing administrative bottlenecks. The stringent sanction are central to this.
The report robustly demonstrates the Authority’s steadfast commitment to transparency, unwavering accountability, and continuous improvement in the provision of healthcare services to beneficiaries.
It also aims to provide a level playing field for all stakeholders within the industry.
Also read: National hospital seeks public-private partnership funding
This is in furtherance of President Bola Ahmed Tinubu’s vision to make Universal Health Coverage a reality for all Nigerians, ensuring equitable access to quality healthcare.
Source: Read more at thecable.ng
