. NHIA refunds N14.2m, suspends nine hospitals, warns 368 providers
By Our Reporter
The National Health Insurance Authority (NHIA) has intensified its scrutiny of hospitals and other healthcare providers under the health insurance programme after thousands of complaints from enrollees.
The authority’s tougher approach comes as healthcare providers face growing pressure to meet the standards expected under the expanding insurance system.
According to Fiscal Post’s findings at the weekend, NHIA resolved 3,878 complaints, refunded more than N14.2 million to affected enrollees, issued 368 warning letters and suspended nine healthcare facilities for breaches associated with services provided to insured patients.
The enforcement action, disclosed by NHIA Director-General and Chief Executive Officer, Dr. Kelechi Ohiri, comes as health insurance coverage expanded from about 16 million Nigerians at the beginning of the current administration to more than 23 million.
While the increase represents significant progress, the authority acknowledges that coverage alone does not guarantee access to quality healthcare.
Speaking in Abuja at the inaugural Civil Society Organisation-Led Mid-Year Review of Nigeria’s National Health Sector Reforms, Ohiri said the focus of the NHIA was increasingly shifting from expanding membership to ensuring that Nigerians could actually obtain timely and quality treatment when they needed it.
The development highlights one of the biggest challenges facing Nigeria’s health insurance reform: closing the gap between being registered under an insurance scheme and receiving dependable healthcare without being subjected to unexpected financial demands or poor treatment.
The NHIA said inspection teams have now been deployed to healthcare facilities to monitor compliance with its one-hour treatment authorisation policy, as well as other requirements covering patient protection and quality of care.
For patients, the issue is increasingly less about how many people are registered and more about whether their insurance membership translates into actual access to doctors, medicines, diagnostics and treatment when illness strikes.
“We have moved from policy and legislation to measurable implementation,” Ohiri said. “The next task is to move from coverage to reliable access, from reliable access to better health outcomes, and from insurance membership to genuine financial protection.”
The NHIA said recent reforms had also produced significant increases in payments to healthcare providers, with capitation rising by 93 per cent and fee-for-service reimbursements increasing by 378 per cent.
More than 7,500 healthcare facilities have undergone digital assessment under the SafeCare quality framework, according to the authority, as it seeks to strengthen monitoring of providers and improve the quality of services available to enrollees.
Beyond enforcement, the NHIA is also expanding coverage and financial support for some of the country’s most vulnerable patients.
In cancer care, the authority has entered into a cost-sharing arrangement with pharmaceutical company Roche for selected oncology medicines. Under the programme, Roche contributes 50 per cent of the cost, the NHIA pays 30 per cent, while patients contribute the remaining 20 per cent.
Eligible radiotherapy patients can also receive financial assistance ranging from N400,000 to full coverage, while other supported cancer services include mammography, CT and MRI scans, bone scans, diagnostic tests and radiotherapy.
Ohiri described cancer treatment as one of the clearest demonstrations of the importance of health insurance, given the high cost of diagnosis and treatment and the financial burden that serious illness can impose on households.
“For us, coverage has to mean something when people become ill. Cancer is one of the clearest examples of why health insurance matters,” he said.
The authority also reported progress in its HIV and tuberculosis programmes, with more than 51,000 people covered across Anambra, Ebonyi, Gombe and Kwara states as of September 3, 2026.
The beneficiaries include more than 38,000 people living with HIV, over 7,400 drug-sensitive tuberculosis patients and 594 patients with drug-resistant TB.
The NHIA said it had commenced accreditation of more than 2,000 healthcare facilities ahead of a planned nationwide expansion of HIV/AIDS and TB insurance coverage in 2027.
Maternal and newborn healthcare has similarly become a major area of intervention. According to the authority, its programmes have reached more than 93,000 women and newborns, comprising 79,221 women, 7,500 newborns and 6,044 women treated for fistula.
The agency also reported a 22 per cent decline in case fatality at participating maternal health facilities, from 1,042 in the 2024 baseline to 810 as of August 2026.
Despite these gains, the NHIA’s leadership admits that the country’s health insurance system remains far from achieving universal coverage.
More than 23 million Nigerians now covered represents a substantial increase, but it still leaves the overwhelming majority of the population outside the formal insurance system.
Ohiri acknowledged the gap, stressing that the latest enrolment figures should not be interpreted as the completion of the reform agenda.
“We have made substantial progress, but we are not where we need to be,” he said. “Over 23 million Nigerians covered is significant, but it also tells us that there are many more Nigerians who are still outside the system”.
The emerging challenge for the NHIA, therefore, is twofold: bringing millions more Nigerians into the insurance system while ensuring that those already enrolled are protected from poor service, delays, unnecessary payments and other abuses.
The refunds, warnings and hospital suspensions suggest that the authority is beginning to place greater emphasis on the second part of that equation.
For Nigeria’s health insurance reforms to deliver meaningful change, however, increased enrolment will ultimately have to be matched by improved quality of care, stronger provider accountability and genuine financial protection for patients.