Filenews 19 September 2024 - by Marilena Panayi
A total of sixteen doctors specializing in orthopaedics were caught by the Health Insurance Organization's pincers in August, while the case of a urologist who, as it was found, entered claims and asked for compensation for male genital ultrasounds involving women is of particular interest.
At the same time, this urologist was found to be registering claims for compensation and for repeated and unjustified, according to the HIO, ultrasounds to his patients.
Specifically, and according to a relevant announcement by the HIO, "following an investigation, it was found that ultrasound related activities were carried out repeatedly for the same beneficiaries and the same incident within a short period of time without justifying or substantiating this repetition. In addition, there was a requirement to carry out an activity code to female beneficiaries, while this activity is not permissible due to its nature."
The HIO imposed a total fine of €1,000 on the doctor. Regarding male genital ultrasounds in women, the urologist, according to information provided by "F", claimed that he was mistakenly entering the relevant codes in the GHS software.
Regarding the 16 doctors specializing in orthopaedics, the relevant official information from the Health Insurance Organization states that "based on the information before the Organization, it was found that the 16 Orthopaedists proceeded to submit outpatient claims for compensation of activities in violation of the terms and restrictions of the Organization''. It was found, in particular, that those activities were required alone in a requirement and may only be submitted in combination and only together with one or more of the specified activities'.
Simply put, these doctors submitted claims for compensation by entering in the software a code (visit) which, according to HIO regulations, includes a list of operations that must be performed (not necessarily all) during the visit. According to the HIO's findings, while entering this code, which gives greater compensation, doctors did not perform any of the specified operations during the visit.
The 16 orthopaedists were fined differently, ranging from €300 to €500, depending on each case. The total amount imposed on all doctors was €5,000.
As HIO Director Konstantinos Panayides explained to "F", "this announcement is made in the context of the Organization's decision to make public the cases whose investigation is completed and result in the imposition of penalties".
The checks by the HIO, Mr. Panayides said, "are continuous and daily and suspicious, let's call them, entries in the IT system are often detected. All these cases involving the behaviour of service providers within the system are investigated. In cases where the investigation reveals data that concern us and depending on the nature of each case, either administrative fines are imposed, if it is found that the providers have indeed misbehaved, or if an issue arises that needs more investigation, another route is followed with suspension or termination of contracts or in some cases a report to the Police".
Regarding the hospital which, as it had been found, proceeded to false entries in the GHS software and the HIO had given it a deadline to comply with the regulations and correct the errors that had been detected, Mr. Panayides said that "we are waiting for the deadline given to the hospital to expire and then proceed to check what has been done during this period".
