The National Health Insurance Authority (NHIA) has sanctioned 49 wandering health facilities (HCF) and 47 health maintenance organizations in 2024 according to its operational guidelines.
This continues with its renewed approach in improving the quality of service to registered Nigerian patients.
A statement signed by the Interim Director of Media and Public Relations, Emmanuel Ononokpono, declared that the action followed the investigations on the complaints received from patients registered in the state and national health insurance schemes.
The key problems registered in complaints against HCFS were: indispensibility of medicines, denial of services, payment of pocket for covered services and not provision of payment narratives. For HMO, problems related to delays or denials of reference authorization codes, delays in the liquidation of agreed payments agreed, refusing to monitor the quality guarantee in the facilities, etc.
These are some of the most prominent aspects of the 2024 annual complaints reported by the NHIA compliance department under the interim director, control of the law, Dr. Abdulhamid Habib Abdullahi. The report was issued in accordance with NHIA 17 of 2022, which requires NHIA to establish mechanisms to receive and resolve complaints by members of the schemes and medical care centers.
In total, a total of 3507 complaints were managed during the period, of which 2929 complaints (84%), most of which were against the HCFs were resolved.
A breakdown of the distribution of complaints reveals that 2273 were reports against HCFs, 1232 were against HMO. Only two reports were registered against the affiliates by the suppliers.
According to the result of the investigations, several sanctions were imposed on medical care providers when indicated. Eighty -four (84) formal warnings were issued to HCFS, while 54 affiliates received reimbursements of N4,375,500 of 39 HCF. Four HCFs were suspended and six were eliminated. 35 hours also received warning letters and directives to institute corrective actions, while 12 hours were ordered to reimburse a total of N748,200 to 15 affiliates.
According to the report, in 2024, all complaints were completely investigated and responded within the standard response time of 10 to 25 days. The average resolution of complaints for complaints that required the investigation was 15 days. The complaint resolution rate (within the timeline) was 84%. When the problems could not be solved within the deadlines, an explanation was provided to the plaintiffs while the resolution process continued. The complaints received in 2024 were presented through the following routes: letters in person, writing, email, telephone, the call center of NHIA and other channels.
The NHIA management protocol and management management establishes clear policies and procedures for complaint management and establishes that complaints must be responded in a timely manner. It also provides climbing procedures for complex or serious complaints.
Speaking about development, NHIA DG, Dr. Kelechi Ohiri described the NHIA complaint management process as an organic for the agency's efforts to improve responsibility, rebuild trust and improve the quality of care. Ultimately, this will promote greater registration by encouraging suppliers to offer current affiliates an improved service.
“Affiliates deserve the best attention and we will continue doing everything possible to ensure that they obtain it. The sanctions are intended to send a clear message that the NHIA will not tolerate the lower quality service for affiliates.”
Ohiri added: “We praise suppliers who provide high quality services to our affiliates. They are worthy partners on our collective trip to UHC. With the recent increases in capitation of capitation and rate for service to suppliers, the first in 12 years, we hope they are carried out more for patients, no less. We must continue working to reduce the delay in recent care.”
Beyond the sanctions, NHIA has also established additional policies. The NHIA has also issued a circular that requires a one -hour limit for the issuance of reference codes for treatment. If HCFs do not receive an HMO response within 1 hour for registered patients, they must start treatment based on the protocol established to treat such situations.
The report demonstrates the commitment of the authority to transparency, responsibility and continuous improvement in the provision of medical care services to beneficiaries and provide a level of play for all interested parties in the industry. This is to promote the vision of President Bola Tinubu's vision of making universal health coverage for all Nigerians.