Three specialist doctors, two private physicians, three clinics, one dentist, one nurse, 16 clinical laboratories, and two pharmacists exited the General Health System (GHS) in 2023, and some of them were referred to the Police.
Simultaneously, in dozens of cases, the Health Insurance Organisation (HIO) imposed fines or suspended contracts of professionals, and their cases are still under investigation, while the relevant departments of the HIO are preparing to expand control programs that began the previous year, initially focusing on abuses in diagnostic examinations, specifically magnetic resonance imaging.
As reported to Phileleftheros by the director of the HIO, Maria Kythreotou, in 2023, a total of 10 specialist doctors were investigated.
In three cases, contracts were terminated following the investigation, and in two of these cases, the matter was referred to the Police.
For three doctors, the suspension of their contracts was lifted, and their contracts were reinstated, while the cases of four doctors are still under investigation.
The reasons why these 10 doctors were initially investigated were that it was discovered (either through complaints or through the GHS software) that they submitted claims for compensation for procedures they had not performed.
Three private clinics of the GHS were also investigated.
In one case, where surgical procedures performed in the public hospital by government doctors were subsequently registered under the names 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, contracts for a total of 16 clinical laboratories were terminated.
Most of these cases arose after the suspension of the operating licenses of the laboratories by the Clinical Laboratories Inspector of the Ministry of Health.
In addition, the contract of a dentist was terminated, who was registering claims for services provided to beneficiaries he had never served, and the contracts of two pharmacists/pharmacies were also terminated.
In one case, the pharmacist was proven to have engaged in abuses, and in the second case, the pharmacy’s operating license was suspended by the Ministry of Health.
Currently, according to Mrs. Kythreotou, there are 5-6 other pending cases.
In addition to the specific cases involving the termination or suspension of contracts, the HIO is investigating dozens of other cases related to abuses, not necessarily fraud or potential fraud.
As stated by the director of the HIO, Constantinos Panagides, in 2023, these cases reached 260, and fines were imposed for 30 of them.
“The remaining cases are still under investigation, as the process followed is time-consuming, and these cases are investigated either based on complaints that reach us or spontaneously.”
In addition to the specialist doctors, who were investigated, the HIO has expanded its controls to other providers, specifically those belonging to the groups of other healthcare professionals (physiotherapists, occupational therapists, speech therapists, clinical dieticians, and clinical psychologists).
In cases where “a question of medical judgment or medical opinion arises,” the organization uses experts with whom they collaborate to process the data.
In cases where various phenomena are identified in the GHS software by the organization, a different process is followed. However, the positions of the providers under investigation are always sought.
It is reminded that as part of these controls, the organization conducted an extensive investigation in 2023 into three medical specialties (orthopedics, neurology, and neurosurgery) regarding the increased number of referrals for magnetic resonance imaging issued by doctors.
From these specific controls, it was previously published that one out of two referrals issued could have been avoided.
“With the completion of this specific program, we will start studying the areas in which we will expand our controls to decide whether to continue with diagnostic imaging or move on to other types of services,” said Mr. Panagides.
