Filenews 24 August 2023 - by Marilena Panayi
An entire ring that operated between two provinces was recently set up with clinicians and doctors allegedly involved.
Who knew and who did not know exactly what was happening will be revealed by the investigation of the Health Insurance Organisation and probably also of the Police, while for the time being the HIO has suspended the contract of a clinic and a doctor who allegedly took an active part in what was happening.
The case, according to information provided by "F", reached the HIO after a relevant complaint. In this clinic, surgeries were performed by a specific GHS doctor, who comes from a province other than the one in which the clinic with which he is not affiliated is based.
For reasons probably related to his employment status (which does not concern the HIO), claims for compensation from the organization for the operations he performed were submitted in the name of another colleague, of the same specialty, contracted to the specific clinic. The same tactic was followed in the case of the anaesthesiologist who participated in these operations, since, as it emerged from the preliminary investigation of the HIO, another anaesthesiologist was present at the operating room and in the name of another the claims for compensation were submitted to the organization.
During the preliminary investigation, the HIO received statements from patients who had undergone these surgeries and from what they reported, some of them, probably confirms the information that was initially given to the HIO through the relevant complaint. That is, that the names of the doctors (surgeon and anaesthesiologist) who were inside the operating room are not the same as the names of the doctors who were then presented in the GHS software.
As part of the investigation of the case, a team of the HIO together with inspectors from the Ministry of Health also visited the specific clinic and on August 4, the organization officially informed the clinic that its contract with the GHS is suspended.
As the agency states in its letter to this clinic, the investigation found that:
– The clinic submitted requests for reimbursement for inpatient operations to the IT system by entering the names of doctors contracted with the clinic, while the operations, with the knowledge of the clinic, were performed by other, non-contracted doctors.
– The clinic registered in the IT system claims for compensation for incidents that presented as in-hospital, while these are reimbursed by the organization as out-of-hospital.
It is reported that this clinic had previously been of concern to the HIO, since there, as it was found, a specific doctor whose case is before the Police was performing medical procedures by registering them again in the name of another doctor who is not even in Cyprus.
In addition to this clinic, a letter for contract suspension was received on the same day by one of the allegedly involved doctors (contracted with the clinic). This is the surgeon in whose name the operations performed by his colleague from another province were registered. The case of the doctor who performed the operations is under investigation as other issues may arise which also need to be investigated.
However, some of the doctors allegedly involved have declared ignorance of what was happening, despite the fact that their names are included either in the initial complaint, in patient reports or in the GHS software. The scene, of course, will become clear when the investigation by both the organization and the Police to which the HIO has turned is completed.
In the meantime, the Health Insurance Organization recently suspended the validity of a physiotherapist's contract. This health professional, as we are informed, registered in the GHS software claims for compensation for acts that he had not performed. In some cases, while actually serving patients, it was found that he was registering in the system a claim for compensation for a service other than the one he had actually provided.
