Health Insurance Fund required institutions to return €700,000 last year
After checking the substance and accuracy of health insurance benefit claims, the Health Insurance Fund required health service providers to return nearly €700,000 last year.
The Health Insurance Fund's supervisory department regularly conducts queries and data analyses in the medical billing database to assess the accuracy and justification of the data presented on medical bills and to detect discrepancies. This ensures that paid healthcare bills, reimbursable discounted prescriptions and disability certificates are justifiably submitted.
Based on standard queries, nearly 32,500 invoices were checked last year, of which 3,198 were found to be unjustified, amounting to €170,305.
Last year, 213 inquiries and complaints were submitted to the supervisory department. Based on these, the correctness and justification of health insurance benefits were checked 226 times, sometimes requiring the review of multiple medical institutions.
There has been a significant increase in complaints related to the accuracy and justification of issuing disability certificates. A total of 252 disability certificates were checked based on 91 complaints, resulting in claims against 72 certificates amounting to €19,989.
The Health Insurance Fund processed disputes over medical bills submitted through the health portal 90 times and checked the activities of partners ten times based on inquiries from the State Agency of Medicines, mainly concerning the correctness of prescription issuance. Claims were made for €4,276.
Targeted thematic controls were conducted ten times, comparing the medical invoice's alignment with the patient's medical record. This included verifying whether the services reflected on the medical bill were actually provided to the patient as per the medical document and whether the provided healthcare services were medically justified.
"Many claims often stem from inadvertent errors by healthcare institutions, such as coding errors on invoices or inaccurate service reporting. However, if systematic and intentional fraud is detected, penalties are imposed, contracts are terminated and if necessary, the police are contacted," said Jelena Kont, head of the Health Insurance Fund's Supervisory Department.
--
Follow ERR News on Facebook and Twitter and never miss an update!
Editor: Mirjam Mäekivi, Marcus Turovski
