Filenews 24 May 2025 - by Marilena Panagi
AI will "read" the millions of entries in the software of the General Health System, analyze them and give indications to the Health Insurance Organization for possible fraud, abuse or even bad practices that affect the quality of the services provided. A large team of experts has already set to work on its "construction" with the ultimate goal, with the completion of all procedures, the integration of Technical Intelligence into the GHS.
The reason for the new electronic system that the HIO is preparing and will aim to analyze data and control all entries made in the GHS software. The new system will be able, in parallel with the control exercise, to analyze the data and give indications on the quality, use or abuse of the services provided.
The procedures for the creation of this new program have begun, the tender has been completed and the project has been awarded to a specific specialized House, while yesterday the first presentation of the Organization's goals and requirements to the contractor and its partners took place.
"This is a huge and grandiose project", the director of the HIO, Konstantinos Panagidis, told "F", adding that "in order to achieve the goal of the Organization, and the planning that has been prepared, a team of experts, the contractor company and its subcontractors, as well as two directorates, the IT Directorate and the Requirements Directorate of the HIO, will work".
The system, which is being promoted for construction, explained the director of the HIO, "will be able to proceed with the analysis of the data resulting from the registrations of the GHS service providers and will be able to identify cases that constitute fraud or even abuses".
"When we as an Organization have these indications at our disposal, we will be able to proceed, as the case may be, either to the investigation of a case and the imposition of a penalty, if necessary, or to other interventions, for example the application of measures or restrictions to avoid abuse."
In addition, "our goal is for the system to proceed with the verification of claims for compensation submitted by providers and to provide indications in cases where there may be mistakes made either by negligence or on purpose".
The design of the HIO does not stop here since, according to Mr. Panagidis, this system will also be able to control the services offered per category of patients.
"For example, we have the group of diabetics who have the same characteristics. The system will be able to analyze the practice followed by our doctors in the management of these patients, the tests they refer to, the frequency of examinations, the medication, etc. We will be able to identify cases in which a patient, who belongs to this particular group, receives either more or fewer services. When we have this data, we will be able to see if there is abuse or if the patient has some peculiarities that require more tests or if this patient does not receive the services he really needs. In both cases, the Organization will be able to act for the benefit of the patient and certainly for the benefit of the System".
With these data, "you understand the size of the project that is being promoted for implementation with the aim of creating the mechanism that will lead us with the use of Artificial Intelligence to the monitoring of the System".
At the moment, Mr. Panagidis said, "working groups are being set up at the HIO with the involvement of all the Organization's directorates, since our requirements for the various groups of services provided must be defined and recorded. The data are different when we want to control and monitor radiodiagnostic services, others for services related to medicines and others for inpatient care".
"In any case, we have a long way to go and a lot of work ahead of us. We are now starting, but surely our goal is to complete it as soon as possible, of course respecting the proportions because the project is both difficult and complex and certainly cannot be done overnight. Do you understand what it means to create, from the beginning, an electronic system that will be able to safely analyze all the data that is registered daily in the IT system of the GHS and even have the ability to provide us with the information that is stored in the GHS IT system. gives specific indications".
It will work independently of the software
The project will cost the Health Insurance Organization more than €600,000 and according to a timetable that has been set, it will be completed in 30 months (two and a half years).
It will not be part of the General Health System software but will analyze the data entered in the software without interfering with it.
For its use, as the director of the HIO explained, "officers of the Organization will be trained who, when the project is completed, will be able to manage it".
"It will essentially be another tool in the hands of the Organization to strengthen our controls and certainly in the process, in all likelihood, we will enrich it with even more possibilities," said Mr. Panagidis.
"We have been working on the preparation of the project for some time, as you can see, the tender has been completed and now, since we have the contractor, we have proceeded to present our requirements and goals. During the first presentation, we explained the way the General Health System works, what it offers and what it is that we are striving for".
The GHS software, "is a system that provides us with many possibilities, it has freed us from many processes from which other health systems in the world have not yet been extricated and now we are going to create a new system that will help us control everything that is registered in the software in order to exercise proper and effective control".
