Filenews 4 December 2025 - by Marilena Panayi
The Health Insurance Organization paid twice for the same biopsy, since in addition to the compensation it paid to the hospitals that served the patients, it then also reimbursed the laboratories that performed the histopathological examinations.
As a result, the bill for the HIO went up, until the relevant control led to the imposition of administrative fines on a total of four hospitals.
Specifically, and according to information from "F", after a relevant investigation and after checking all the data that had been registered in the GHS software by the specific providers, the way in which the HIO paid twice for the same tests and the same patients was ascertained.
In the relevant announcement of the HIO it is stated that: "submission of outpatient claims for histopathological processes regarding histopathological biopsies taken during inpatient hospitalization, the cost of which is included in the fee resulting from the weight of the corresponding DRG and therefore the submission of a claim for them, beyond the requirement of the hospital, is not allowed".
In practice, the performance of histopathological biopsies is part of the determined total compensation of hospitals for these cases. The hospitals, however, despite the fact that they are reimbursed for the biopsies, issued referrals and the examination was carried out in the specialized laboratories which in turn submitted their own claims for compensation to the Organization.
Following this finding, the HIO, from the moment the laboratories had carried out the examination and were justifiably compensated, proceeded to impose a total fine on the hospitals and at the same time recovered the tens of thousands of euros it had paid as compensation to the hospitals for the specific services.
Last month, however, an administrative fine of €15,000 was also imposed on a fifth GHS hospital, which registered outpatient services as inpatient in the software, thus increasing its compensation.
In this case, according to the findings of the HIO, the hospital used codes that refer to the service of patients, who are admitted for hospitalization, when in reality this was not the case.
"Submission of in-hospital requirements for medical procedures included in the list of outpatient activities and for which their codification with the DRG system is not justified and/or documented".
Simply put, patients who would undergo a specific urological examination were served in a hospital, but without the need to be admitted to a ward. That is, they went to the hospital, underwent the test and returned home.
The hospital, however, then entered codes and asked the HIO for compensation corresponding to the service of a patient, who was in hospital, thus increasing the amount that the Organization would have to pay.
