The Public Accounts Committee of the House of Representatives has issued a directive to the Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, to provide a comprehensive list of Health Maintenance Organizations (HMOs) indebted to the Federal Government. The debt, amounting to N49 million, spans from 2021 to 2025 and was uncovered during the committee’s review of the Auditor General’s 2021 report.

The report highlighted the hospital’s failure to recover outstanding debts from HMOs, revealing an unrecovered sum of N32 million from 33 HMOs as of December 31, 2020. Despite these debts, the hospital continued to provide services to these organizations, many of which had substantial arrears.

OAU Teaching Hospital Challenges in Debt Recovery

During the hearing, the Chief Medical Director of OAUTH, Professor John Okeniyi, explained the difficulties the hospital faces in recovering debts from HMOs. He emphasized the hospital’s commitment to providing healthcare services to all Nigerians, regardless of their ability to pay.

“It’s very difficult to refuse to treat Nigerians coming to our hospital, regardless of their inability to pay,” Okeniyi stated. He lamented the low coverage of Nigerians by the National Health Insurance Authority (NHIA), which forces many patients to pay out of pocket. Those covered by NHIA often rely on HMOs, which are known for delays and underpayments.

Okeniyi also addressed specific issues with two HMOs responsible for covering Obafemi Awolowo University students. “Students are expected to receive their tertiary care at our hospital, but when they come, we provide services, and the HMOs do not reimburse these fees,” he added.

OAU Teaching Hospital Efforts to Recover Debts

Despite these challenges, OAUTH has taken steps to address the issue. The hospital established a task force, led by the head of NHIA, Mr. Lekan Orabiyi, to recover the outstanding debts. Okeniyi reported that the hospital has successfully recovered N15.97 million out of the N32 million identified in the Auditor General’s 2021 report.

However, the total indebtedness of HMOs to the Federal Government has risen to N49 million as of 2025. This increase underscores the ongoing challenges faced by the hospital in securing timely payments from HMOs.

Committee’s Directive

In response to the revelations, the Public Accounts Committee, chaired by Mr. Bamidele Salam (Osun, PDP), directed OAUTH to submit a detailed list of the indebted HMOs and the specific amounts owed. The committee emphasized the importance of transparency and accountability in addressing the issue.

The directive aims to ensure that the hospital and the Federal Government can take appropriate action to recover the debts and prevent similar situations in the future. The committee also called for stricter oversight of HMOs to ensure they fulfill their financial obligations to healthcare providers.

Broader Implications for Nigeria’s Healthcare System

The issue of unpaid debts by HMOs is not unique to OAUTH. It reflects a broader challenge within Nigeria’s healthcare system, where healthcare providers often struggle to secure timely payments from insurance organizations. This situation places a significant financial burden on hospitals, affecting their ability to provide quality care and maintain essential services.

The low coverage of Nigerians by the NHIA exacerbates the problem, as many patients are forced to pay out of pocket for healthcare services. This highlights the need for expanded health insurance coverage and improved efficiency in the operations of HMOs.

Calls for Reform

The revelations from the Public Accounts Committee hearing have sparked calls for reforms in Nigeria’s health insurance system. Key recommendations include:

1. Strengthening Oversight of HMOs: Implementing stricter regulations to ensure HMOs fulfill their financial obligations to healthcare providers.
2. Expanding Health Insurance Coverage: Increasing the number of Nigerians covered by the NHIA to reduce out-of-pocket payments and improve access to healthcare.
3. Improving Debt Recovery Mechanisms: Establishing more effective systems for recovering outstanding debts from HMOs.
4. Enhancing Transparency: Ensuring that healthcare providers and government agencies have access to accurate and up-to-date information on HMO payments and debts.

Conclusion: A Path Forward

The N49 million debt owed by HMOs to OAUTH highlights the financial challenges faced by Nigeria’s healthcare providers. While the hospital has made efforts to recover some of the debts, the rising total underscores the need for systemic reforms to address the issue.

The directive from the Public Accounts Committee is a step in the right direction, emphasizing the importance of transparency and accountability in the healthcare sector. By implementing the recommended reforms, Nigeria can strengthen its health insurance system, improve access to healthcare, and ensure that hospitals like OAUTH can continue to provide essential services to all Nigerians.

Related Stories and Historical Context

• The State of Health Insurance in Nigeria: An overview of the challenges and opportunities in expanding health insurance coverage.
• The Role of HMOs in Nigeria’s Healthcare System: Exploring the impact of HMOs on healthcare delivery and financing.
• Financial Challenges in Nigeria’s Public Hospitals: A look at the financial pressures faced by public healthcare providers.
• Lessons from Other Countries: How other nations have addressed similar challenges in their health insurance systems.
• The Importance of Transparency in Healthcare Financing: Why accountability is crucial for the sustainability of healthcare systems.

As Nigeria works to address the challenges in its healthcare system, the lessons learned from the OAUTH case can guide efforts to build a more efficient, transparent, and equitable health insurance system. By prioritizing reforms and strengthening oversight, the country can ensure that all Nigerians have access to quality healthcare services.