Filenews 5 February 2022 - by Marilena Panagi
In 2017 they declared incomes of €36,000 and in 2020, after joining the GHS, their incomes soared to €600,000. The average income of GHS specialists for outpatient services reaches €77,000, however, the audit conducted by the Audit Office shows that some doctors have not only more than doubled their earnings based on the tax returns they submitted in the years before the GHS implementation, but have reached levels that probably indicate on the one hand an abuse of the System, and on the other hand, the possibility of tax evasion in previous years.
Specifically, 67 medical specialists, as recorded in the report of the Audit Office for the HIO, which was published yesterday, "had earnings of more than € 300,000''. Several of them had not filed a tax return for the years 2018 and 2019, while those who had filed a tax return for the years 2017, 2018 and 2019, their declared income was clearly lower than what they received from the HIO."
In its report on the Health Insurance Organisation, the Audit Office stresses the need to adjust the GHS budgets, arguing that if the HIO does not do so, then this must be achieved either by the intervention of the Government and a relevant decision of the Council of Ministers, or by intervention of the Parliament during the budget voting process.
The report, in addition to the abuses identified, makes extensive reference to the differentiation that according to the Audit Office is observed between the actuarial study conducted before the GHS and the current costs of the System, while it analyzes in detail the issue that the Service had identified for some time and concerns the presence of doctors outside the GHS in hospitals of the System. (On this issue, a consultation is underway between the Ministry of Health, the Legal Service and the HIO for its settlement).
In addition, the report highlights the delay observed by the HIO in the integration into the GHS of all the services provided for by the design and legislation governing the operation of the System. Particular reference is made to the Services that still remain in the Organization of State Health Services or the Ministry of Health, but also to the refusal, in some cases of the HIO, to proceed at this time to the necessary procedures.
It does not need to be modified but strictly applied
"We have not identified any aspects of the legislation for which to propose amendments, but this does not mean that with its long-term implementation, there will be no room for further improvement."
In general, it has been found that:
> The agreements that the HIO has concluded with the health service providers, allow them to have super-profits that in some cases can be characterized as profiteering.
> The controls carried out by the HIO allow and sustain abuses, both because of the very low frequency of substantive checks, and because of the almost complete absence of dissuasively severe penalties against the offenders or abusers of the system.
According to the Audit Office:
> HIO must understand that the abuses concern the HIO itself. The position publicly expressed by the HIO that due to the overall budget abuses by one provider concern the other providers of the same category and not the HIO, is the main source of the problem of the non-decisive fight against abuses. To this end, controls should be stepped up and dissuasive penalties imposed.
> HIO, it must balance its budget starting with the 2022 budget. If it fails to do so, the Council of Ministers and the House of Representatives must enforce it through the approval of its budget.
Doctors' incomes skyrocketed
The research reveals the huge differences between what was declared as incomes in the pre- and post-GHS era.
The data and figures recorded in the Report confirm the abuses that exist in the General Health System by some service providers.
Specifically:
> On 31.12.2020 there were 1,514 medical specialists registered with the GHS.
> The total amount of compensation of specialists for 2020, for outpatient health care services, amounted to €116,762,682 or an average of €77,122 per doctor.
> Of these, 440 doctors are registered as legal entities.
> Sixty-seven had earnings in excess of €300,000.
> Eleven had incomes above €500,000 in 2020.
> A doctor's highest fee was €870,742.
> Pair of gynaecologists received together in 2020 a fee of €1.4 million. for outpatient health care services only.
From a further audit conducted by the Tax Department, for doctors with a total compensation for 2020 exceeding €300,000, it was found that:
> Several of the doctors had not filed a tax return for the years 2018 and 2019, while those who had filed a tax return for the years 2017, 2018 and 2019, their declared income was clearly lower than what they received from the HIO.
The Audit Office provides tables with specific examples of doctors who, upon joining the GHS, appear to have more than doubled their income, compared to what they declared in their tax returns in the pre-GHS era.
SPECIALIST DOCTORS
> Doctor stated in his tax return for 2017 that he had incomes of €36,000. For 2018 and 2019 there is no data. In 2020, through the GHS, he had income of €600,000.
> Doctor stated in his tax return for 2017 that he had income of €36,000. The same for 2018, for 2019 there is no data. In 2020, through the GHS, he had income of €600,000.
> Doctor stated in his tax return in 2017 that he had incomes of €55,662 and in 2018 €78,347. For 2019 there is no data. In 2020, he had income of €600,000 through the GHS.
> Doctor had declared in 2017 income of €78,926, in 2018 income of €66,931 and in 2020 through the GHS he had income of €500,000.
> Doctor, had declared in 2017 income of €14,456, in 2018 income of €49,948 and in 2020 received through the GHS €400,000.
As far as personal doctors are concerned, the Audit Office states in its report that:
> The total compensation of PDs amounted to €84,630,601 or an average of €109,342 per doctor.
> Amount of €1,800,500 relates to compensation for births.
> €451,740 compensation for recording the medical history of patients.
> Noteworthy is that the remuneration of a single personal doctor for children (paediatrician) reached €421,283.
PERSONAL DOCTORS
For personal doctors, the Audit Office analyzes more the age of 92 doctors, who are over 70 years old, and in the tax department they are in some cases inactive since the 1990s.
Specifically:
> Out of the total of 774 personal doctors, 92 doctors are over 70 years of age (11.8%), with the oldest doctor being 83 years old.
> Of the 92 above doctors, five were for a large number of years unknown to the Department of Taxation.
> Two of the five had incomes in 2020 of about €200,000 each.
> One last filed a tax return for 1992 and the other filed a tax return until 1996, then for 2000 and the last time for 2017.
> For the remaining 87, the content of their tax returns was not examined, they were simply found to be tax-active.
> The remuneration of personal doctors depending on the number of beneficiaries registered in their list ranged from €43,502 to €421,283
> The majority of personal doctors had earnings ranging from €123,846 to €267,587.
As far as hospitals are concerned, according to the Report: "The 20 largest in compensation (in 2021) private hospitals had an increase of 46%, compared to the declared cycle of inpatient services in 2018, without even taking into account for 2021 the revenues from the provision of health care services to non-GHS beneficiaries (e.g. foreign nationals) and/or GHS beneficiaries from whom illegally (but with the tolerance of the HIO) they were receiving a fee."
