The Health Insurance Organisation (HIO) is developing artificial intelligence tools and piloting a system to detect photographs reused to document different health services, as it widens its checks on misuse of the General Health System (GHS). Its automated checks stopped claims worth an estimated 200 million euros from being submitted in 2025, and its board has approved a bill for stricter penalties, Stratis Matthaiou of the civil servants’ union PASYDY told Phileleftheros.
Matthaiou chairs a committee that the HIO’s board set up to draw up and implement a specialised plan to tackle misuse of the system. He said the automated rules in the HIO’s IT system were triggered about 2.2 million times last year, and that the 200 million euros was the indicative value of claims that were incorrect or not allowed and whose submission was prevented.
The figure should not be confused with money recovered or with proven cases of fraud, he said, adding that “preventing a claim does not automatically constitute a finding of fraud”.
Checks on about 855,000 claims worth about 181 million euros in 2025 led to offsets and corrections of about 19 million euros, Matthaiou said. Administrative fines were also imposed in 46 cases, and two provider contracts were terminated.
Tools and penalties
The HIO combines automated rules, sample checks before payment and targeted investigations, and is developing advanced data analysis and AI tools to detect unusual behaviour. The first phase, covering the technical infrastructure and the reporting environment, has been completed. Some tools have been delivered and are being evaluated.
“Technology supports investigation and better targeting of checks,” Matthaiou said.
The organisation is drawing on foreign expertise through partnerships with bodies from well-established health systems and through international knowledge-sharing networks. It uses the findings from its checks to revise rules and procedures and prevent similar cases in future.
The amending bill approved by the board provides for stricter penalties and higher administrative fines. It would also extend the period within which the HIO can offset amounts it is owed. Matthaiou said the changes would strengthen the means available to tackle breaches.
“Every resource that is protected remains available for patients’ needs,” he said. Misuse burdened the system and affected how resources were allocated, he added, and tackling it was directly linked to the quality of care and the sustainability of the GHS.
Checks and patients
The checks cover laboratories, pharmacies, hospitals, doctors and other health professionals. They focus on unnecessary referrals, excessive use of tests, incorrect coding and claims without adequate documentation, with particular attention to inpatient care because of its financial size. Matthaiou explained that every finding was assessed and investigated, so that measures were based on documented evidence.
He said curbing misuse was not only a matter for healthcare providers, as services, tests, referrals and treatment should rest on documented medical need and the scientific judgement of health professionals. Patients, he said, “are called on to respect the clinical assessment and refrain from exerting pressure for services that are not deemed medically necessary”.
He also urged patients to send the HIO their views, suggestions and complaints. The organisation uses this feedback to identify problems, investigate possible irregularities and improve its procedures and services, he said.
