Filenews 16 January 2024 - by Marilena Panayi
Three specialist doctors, two personal doctors, three clinics, one dentist, one nurse, 16 clinical laboratories and two pharmacists saw the exit door from the GHS during 2023 and some of them were referred to the Police.
At the same time, in dozens of cases, the Health Insurance Organization has imposed fines or suspended the contracts of professionals and their cases are still under investigation, while the competent departments of the HIO are preparing to expand the control programs that began last year and initially concerned abuses in radiodiagnostic tests and specifically in MRI scans.
As HIO Director Maria Kythreotou told F, during 2023, a total of 10 specialist doctors were investigated. In three cases, after investigation, the contracts were terminated, while in two of these three cases the case was referred to the Police.
For three doctors, the suspension of their contracts has been lifted and their contracts have been reinstated, while four doctors' cases are still under investigation. The reasons why the 10 doctors were initially investigated was the fact that it was found (either following complaints or through the GHS software) that they were making claims for compensation for acts they had not performed.
Three private GHS clinics were also under investigation. In one case, in which it was established that surgeries performed at the hospital by public doctors were then registered in the name of private doctors, the case was reported to the police. The other two cases involved small clinics whose operating licenses were suspended by the Ministry of Health.
In 2023, the contracts of a total of 16 clinical laboratories were terminated. Most of these cases occurred after the suspension of the operating license of the laboratories by the Superintendent of Clinical Laboratories of the Ministry of Health.
In addition, the contract of a dentist who registered claims for compensation for the provision of services to beneficiaries whom he never served was terminated, while the contracts of two pharmacists/pharmacies were terminated. In one case, the pharmacist was demonstrably abusive and in the second, the pharmacy's operating license was suspended by the Ministry of Health.
At the moment, Kythreotou said, there are another 5-6 cases.
In addition to the specific cases involving termination or suspension of contracts, the HIO investigates dozens of others involving abuses rather than fraud or potential fraud. As HIO Director Konstantinos Panayides told "F", these cases reached 260 in 2023 and for 30 of them a fine was imposed.
"The rest of the cases are still under investigation since the process followed is quite lengthy and these cases are being investigated, either following complaints that reach us or ex officio." In addition to the specialist doctors, who were investigated (cases were recorded for doctors of more than 15 medical specialties), the HIO "has now extended the checks it carries out to other providers, in particular providers belonging to the groups of other health professionals (physiotherapists, occupational therapists, speech therapists, clinical dieticians and clinical psychologists)".
In cases where "medical judgement or medical opinion is involved, the Agency shall use the experts with whom there is cooperation and process the data. In cases where we, the organization, detect various phenomena in the GHS software, another procedure is followed. But we always ask for the position of the providers that are under investigation."
It is recalled that as part of these audits, the organization conducted in 2023 an extensive survey in three medical specialties (orthopaedics, neurology and neurosurgery) on the increased number of MRI referrals issued by doctors. These checks, as already published, showed that one in two referrals issued could be avoided.
"As part of this audit, about 40 letters were sent in the previous days to doctors whose referrals had been investigated by experts," Panayides said.
Upon completion of this program, "we will begin to study the areas in which our testing will be extended to decide whether to continue with radiodiagnostic tests or move to other types of services."
