The Health Insurance Organisation (HIO) is stepping up oversight of the General Health System (GHS) after a US study revealed that 20% of medical procedures are unnecessary, a figure believed to mirror European healthcare systems.
The organisation has reviewed 12 million claims for reimbursement in the first eight months of 2024, rejecting 65,000 claims worth €19 million for being either medically unjustified or exceeding prescribed limits, HIO director Constantinos Panayides told Phileleftheros.
This year, HIO has launched investigations into 132 suspected cases of provider misconduct. Half of these investigations have concluded, resulting in €100,000 in fines, while an additional €40,000 in penalties were imposed for cases from previous years.
“When providers submit claims for procedures they never performed or claim higher reimbursements than warranted, we take action”, Panayides said. “We’ve also uncovered cases of falsified discharge dates and other serious violations”.
The issue of healthcare fraud was recently addressed at a Luxembourg conference hosted by the country’s National Health Fund and the European Union of Social Security Systems, attended by more than 140 representatives from various European countries.
HIO is now developing a programme to monitor patient behaviour following complaints from doctors, including neurologists, about unnecessary visits creating resource strain. While the organisation cannot directly penalise beneficiaries under current legislation, it is considering measures such as visit limits or co-payment adjustments.
“Some health systems can temporarily suspend beneficiaries who abuse services or set caps on visits”, Panayides noted, emphasising that such measures would not affect patients with legitimate medical needs.
The organisation’s IT system automatically flags unusual patterns, though future monitoring will likely rely on random sampling unless specific complaints warrant investigation.
Read more:
