Doctors and other healthcare providers in the General Health System (GHS) could face a maximum age limit, and the Health Insurance Organisation (HIO) could refuse to admit new providers, under two bills to amend the GHS law that are now in public consultation.
The bills would also raise the maximum administrative fine from 30,000 to 300,000 euros, and to 600,000 euros for repeat breaches. They would require insurance companies to pay the HIO annually towards some GHS costs, allow checks on payments going back up to 12 years in cases of fraud, and widen the HIO’s powers of inspection.
Age limit
The provision allowing an age limit is in article 25 of the second amending bill. It applies generally to people providing healthcare through the GHS and is not explicitly limited to any medical specialty or professional category.
The age of personal doctors has been the subject of public debate and has come before parliament in recent years. The proposed text does not say whether any age limit would be the same for all providers, whether there would be exceptions, or whether there would be transitional arrangements for those already contracted with the HIO.
The same article allows the HIO to set a procedure, terms and conditions for readmitting people to the GHS after their registration has been cancelled or their contract terminated.
New providers
Under an amendment to article 38 of the GHS law, the HIO would be able to refuse registration in the GHS, or a contract, to individuals or companies, under conditions set out in the provision. The power is linked to determining the system’s needs and to public interest grounds. These include meeting beneficiaries’ needs, the quality of services, financial sustainability and the protection of public health.
The HIO could also make acceptance of specified terms or restrictions a condition of registration or of a contract. It could impose terms or restrictions on how healthcare services are provided, including on providers already contracted with it and on individuals providing services on their behalf. It could refuse or cancel the registration of such individuals if they do not meet the requirements.
Needs and restrictions would be set through internal regulations, in line with the principle of proportionality.
Enforcement
Fines for repeat breaches would depend on the nature, gravity and duration of the breach. The amounts set in the bills are maximums, not fines that would be imposed automatically for every breach.
The HIO’s director general would be able to carry out retrospective checks on claims that providers have submitted and the HIO has already paid, within three years of payment. That period would be extended where a breach is found to have resulted from fraud.
The HIO would also be able to recover amounts already paid where a breach is documented. Breaches could concern the law, the HIO’s regulations, decisions and circulars, and clinical protocols, restrictions, criteria, quality standards and contractual terms.
The HIO’s investigative powers would be widened to include collecting information, examining documents and electronic records, and inspecting providers’ premises. The bill refers explicitly to the power “to enter, search and inspect premises”. The HIO could also seize or copy documents and records, obtain information from people connected with cases under investigation, and check whether providers apply clinical guidelines, protocols, restrictions, terms and conditions, and criteria.
Substitute doctors
When a personal doctor’s beneficiaries are seen by a substitute, the HIO would continue to pay the personal doctor with whom they are registered and would pay no additional fee to the substitute. Personal doctors could, if they wished, compensate the colleague they appoint as their substitute. The cases, conditions and procedures for substitution would be set by HIO decisions.
Insurance companies
Insurance companies would be required to pay the HIO annually amounts corresponding to part of the GHS’s costs for accidents and occupational diseases covered by compulsory insurance. The amounts would be shared out according to each insurer’s market share.
At present, the HIO covers, among other things, care received by GHS beneficiaries after road collisions, although all drivers in Cyprus are required by law to have insurance.
Internal audit
The bills would also introduce an internal audit framework and an Audit and Public Governance Committee. The Internal Audit Unit would carry out audits under an approved annual programme, as well as special studies and audits on its own initiative on matters that could affect the HIO’s financial sustainability, integrity and operational efficiency. The HIO’s board would be able to delegate powers and responsibilities temporarily, under its control and within set limits.
