The Health Insurance Organisation (HIO) has recovered compensation payments and imposed a fine after discovering that a medical consumables supplier deceived the system by delivering products that were never evaluated or approved by the organisation.
The supplier, according to sources, had been contracted to provide the General Health System (GHS) with a specific product. This product had been evaluated and approved by the HIO following an application for inclusion in the system and the required review process.
The HIO had paid the supplier more than €20,000 in compensation for the units that had been used.
However, the organisation later discovered that healthcare professionals were receiving a different product from the one that had been evaluated, specifically an equivalent product from another manufacturer.
What is particularly notable in this case is that despite the substitution of the approved product with another equivalent, entries in the GHS software were made using the codes of the original product.
After an investigation, the HIO identified the issue and first recovered the entire amount it had paid to the supplier for the products that had been used, then imposed a fine of €5,000.
Meanwhile, a fine of €4,000 was also imposed on a GHS personal doctor who, as determined by the HIO, was issuing referrals to beneficiaries without adequate documentation and justification, while recording visits after the actual presence of his beneficiaries at his office.
Additionally, according to the HIO’s announcement, the doctor was recording follow-up visits for his patients in less than the 30-day period stipulated by GHS regulations, without adequate documentation.
