Insurance fund investigating alleged Põlva hospital COVID-19 invoice fraud ({{contentCtrl.commentsTotal}})

Põlva Hospital.
Põlva Hospital. Source: ERR

Authorities are looking into the activities at a hospital in South Estonia during the coronavirus pandemic, after concerns that fraudulent activities may have been going on in respect of invoicing the health insurance fund for treatments at a time when the emergency situation prevented their going ahead.

Management at the hospital in the Southern Estonian town of Põlva had allegedly been encouraging doctors to keep coronavirus patients on-site after they had recovered, ostensibly for rehabilitation, rather than sending them home or referring them to an outpatient clinic. The hospital could potentially face fines of up to half a million euros if found guilty of defrauding the health insurance fund, which is conducting its own investigation into whether it itself was defrauded.

Daily newspaper Postimees published a letter almost two weeks ago (the letter dated from April 1), in which head of the hospital Margot Bergmann urged doctors to think several times before sending a recovered COVID-19 patient home, and consider sending them for rehabilitation or to an outpatient nurse, or to attend an outpatient clinic.

Scheduled treatment had been suspended at Põlva Hospital since March 26.

The letter attracted the attention from the Health Insurance Fund (EHIF) who then checked the hospitals incoming monies from April and May.

As hospitals could not conduct the majority of scheduled treatments during the peak of the pandemic, from mid-March to mid-May, they were not receiving income from the EHIF, though the latter was covering hospitals' fixed costs, Marko Tähnas of the EHIF told ETV news show "Aktuaalne kaamera" Tuesday night.

Põlva Hospital director: I did nothing illegal

Margot Bergmann said she had done nothing illegal and had not attempted to mislead the EHIF in presenting fictional invoices, adding that the rehab elements of the hospital were lying dormant at the time.

Bergmann skirted around answering whether budgeting issues were also a factor, emphasizing patient's well-being instead.

"It wasn't so much that we were concerned about earning that extra money or fulfilling a contract, but rather that when these patients we already have in the hospital usually need the next stage of their treatment, they would normally get it right away," Bergmann said.

The EHIF can fine a hospital up to €500,000 for filing erroneous invoices, which Marko Tähnas said was sufficiently a Sword of Damocles of its own to ensure hospitals played ball, though investigations could still look into suspected deliberate fraud.

The EHIF's decision, following its inspection, will be announced in the fall.

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Editor: Andrew Whyte

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