Filenews 17 March 2022 - by Marilena Panagi
5,000 doctors' and other GHS health service providers have passed through a sieve, from Greek experts, who have recently collaborated with the Health Insurance Organisation and have undertaken, following a relevant contract, the evaluation of the medical and pharmaceutical requirements that were registered in the GHS software in the previous period and concern both outpatient and inpatient care. In fact, as reported by "F", the experts have already identified "suspicious" entries which they will analyze in a special report that they are currently preparing and will hand over to the HIO in the coming weeks.
At the same time, the Organization, as the Chairman of the Board of Directors Thomas Antoniou told "F", "significantly intensifies its efforts, which have been continuous since the first day of the GHS's implementation, to strengthen the control mechanism of the System, while recently, in addition to the Audit Committee that has been in operation for a long time, a risk management committee was established and took up work".
At the same time, said Mr. Antoniou, "we have already had a meeting with the Pancyprian Medical Association with which it was agreed that doctors from all medical specialties will be appointed, who will help us strengthen and upgrade the control mechanism of the System and at the same time the Board of Directors has proceeded to the establishment of a committee, which has undertaken to record suggestions from both providers of the System and other bodies in order to study them in as many cases as it is appropriate to adopt them." In the HIO, Mr. Antoniou concluded, "various committees and subcommittees have been set up and operate as well, such as the Committees of tenders, examination of communication objections, etc. and all aim both at the proper monitoring of all the actions taken by the Organization, and at the way in which what is done by the HIO reaches the right recipients".
Regarding the evaluation of the 5,000 claims by Greek experts, HIO director Konstantinos Panagidis, explained in his statements to "F" that "these are experts of a specialized firm, which deals with the evaluation of the requirements of health providers. During our cooperation so far, 5,000 requirements have been examined and the evaluation was not done by a simple review of the GHS's software system, but a thorough and detailed investigation was carried out which, as we were informed, gave results for which we will soon have a detailed report in our hands".
The assessment concerns, "whether a requirement relating to, for example, a medical act is justified. If this medical procedure had to be done, if it was in accordance with the diagnosis that had been made, etc. It was even examined whether the provider has correctly filled in the clinical notes to justify the actions he has carried out." In anticipation of the results of this "first, let's call it a ''pilot'' evaluation program", said Mr. Panagidis, "the HIO is preparing for a much bigger effort to evaluate the medical requirements, which as planned will begin very soon".
The HIO's aim, he concluded, "is to further intensify its efforts and upgrade the control mechanism of the System in order to limit as much as possible the chances of abuse of the GHS or the possibility of errors and omissions on the part of providers when submitting their claims for compensation by the HIO".
In statements about the special committee that has been set up by the Board of Directors of the Organization and aims to record suggestions for the improvement of the System by all competent bodies, made yesterday the general secretary of PASYDY and member of the Board of Directors of the HIO, Stratis Matthaiou. As he said, "our aim is to have meetings with the Auditor General of the Republic, and with the Ministers of Finance and Health, as well as with all the bodies representing the GHS health service providers. Let's record their suggestions and then see what moves we need to make to upgrade the system's control mechanism." In the GHS, he admitted, "there are abuses and this is something that the Board of directors of the Organization has identified from the beginning. Several actions have already been taken and as it has become known the contract of some providers has already been terminated. Now, we have felt the need to inform people about the moves we are making and at the same time it is imperative that we intensify our control."
"GHS doctors are represented by non-GHS doctors"
Its own intervention was made yesterday by the Scientific Advisory Committee of the Federation of Patients' Associations of Cyprus, which includes among others health professionals who are integrated in the GHS. As the SSC states in its announcement, "we regret to note that 4.4% of the GHS doctors, in numbers i.e. 67 of the 2,600-plus doctors of the System, have become a ''flag'' by some, with the aim of affecting the reform itself, which is the greatest social conquest since the establishment of the Republic of Cyprus and at the same time targeting all doctors who are contracted with the HIO".
Particularly impressive, says the SSC, "it is also surprising that the medical world of Cyprus is represented in the various Bodies, by doctors who are not even integrated into the System, but are the representatives who negotiate for the GHS. At the moment in Cyprus there are around 2,800 doctors (active), of which only 185 have not joined the GHS. However, we note in the various meetings/meetings, inside and outside the House, only doctors who have not contracted with the HIO are invited and express an opinion." A striking example is "the last meeting of the Parliamentary Control Committee, which was attended by a total of four doctors (3 guests and 1 MP), none of whom are members of the GHS".
As far as the control issues of the System are concerned, "the requirement of both the OSAC and the SSC-OSAK is the continuous, detailed and unhindered control of the GHS's operation, since we are the first to stress the need to protect the resources from abuses and overpricing".
On issues related to the pharmaceutical sector, "the ESRB-OSAK with particular concern follows the statements made by official state bodies and indirectly but clearly support a setback in the tendering procedures".
"We sound the alarm and call on the citizens to join the OSAK and those who have supported and continue to support the GHS", the statement concludes.
