FCTA Issues Stern Warning: HMOs to Face Sanctions Over Withheld Payments

The Federal Capital Territory Administration (FCTA) has announced its intention to impose strict sanctions on any Health Maintenance Organisations (HMOs) operating under the FCT Health Insurance Scheme (FHIS) that fail to remit payments promptly to accredited healthcare providers.

The FHIS, designed as a social health insurance programme, aims to ensure equitable, affordable, and quality healthcare for all residents within the FCT. Free enrolment is extended to employees of the FCTA and its Area Councils, as well as vulnerable groups such as pregnant women. Other residents may access the scheme through the payment of an annual premium currently set at ₦22,500.

According to information made available on Tuesday, the Minister of the FCT, Nyesom Wike, has authorized the release of approximately ₦4 billion to clear outstanding payments related to capitation and service fees for the years 2022 through 2024. This move forms part of broader reforms aimed at strengthening service delivery within the scheme.

Daily Post has learned that the FHIS benefit package encompasses a Basic Minimum Package of Health Services (BMPHS), including promotive, preventive, curative, and certain rehabilitative care. These services range from primary care and emergency interventions to dental, mental health, eye, ENT care, physiotherapy, as well as laboratory and radiological investigations like ultrasound and x-rays.

Despite these efforts, complaints have emerged from healthcare providers alleging that certain HMOs are withholding payments under the guise of missing bank details—a justification deemed unacceptable by the authorities. Consequently, compliance by HMOs and the commitment of healthcare providers to their responsibilities will now be closely monitored, with defaulters set to face appropriate disciplinary measures.

In the past year, reforms under the FHIS have also included the clearance of all pending capitation and service payments dating back to 2022, accelerated disbursement of capitation to HMOs, and an upward review of capitation rates to enhance service quality for enrollees. Furthermore, vulnerable populations—particularly pregnant women, children under five, and indigent persons—have begun receiving healthcare at no cost.

Over 100 primary healthcare facilities have undergone accreditation visits to expand service access across communities in the FCT. Through the Basic Health Care Provision Fund (BHCPF), pregnant women enrolled in Primary Health Centres across the six Area Councils will continue receiving free health education, consultations, medications, routine antenatal drugs, diagnostic tests, and delivery services.

Patients requiring advanced maternal care, including cesarean sections, blood transfusions, and treatment of severe obstetric conditions such as eclampsia, will also be referred to any of the 14 General Hospitals in the FCT at no cost, in line with the BHCPF guidelines.