Control of the health insurance funds enabled to evade million of Eur in damage to CHIF


2022 06 13


Last year, consistent consulting and monitoring of healthcare institutions, pharmacies, opticians and other economic entities, conducted by the health insurance funds, enabled to evade more than one million Euro in damage to the Compulsory Health Insurance Fund (CHIF), says the analysis, conducted by the National Health Insurance Fund (NHIF) under the Ministry of Health.

According to the study, last year, the number of control procedures, conducted by Territorial Health Insurance Fund departments (THIF) was 49 per cent higher (889) than in 2020 (598). Meanwhile, the total annual amount of CHIF funds, unduly received by economic entities was 16.6 per cent lower than the year before, amounting to 466 thousand Eur.

According to NHIF experts, the decreasing amounts of CHIF funds unduly received and thus regarded as damage to CHIF, is a positive result. THIF aims to ensure that institutions provide patients with services that comply with the law, and thus engage in active consulting, enabling the healthcare institutions to correct inaccurate data.

Last year, like the year before, a lot of attention was focused not only on finding cases of non-compliance, but also their prevention and methodological support in making timely corrections of incorrect statistical data. This enables to prevent unreasonable payments from CHIF, while healthcare institutions, pharmacies, opticians and other economic entities do not cause any damage to the fund. According to calculations, last year, THIF reviewed more than a million statistical data items and thus prevented more than 1 million and 32 thousand euros of damage to the CHIF.

Economic entities – pharmacies, opticians and healthcare institutions – offering healthcare services that do not comply with legislation requirements, engage in violations that repeat from year to year, must remunerate the damage, i.e. return the funds, unreasonably received from CHIF back to the fund. The highest amount of damage in 2021 was identified by Klaipėda THIF, amounting to more than 290 thousand Eur, while the lowest – Šiauliai THIF with nearly 6 thousand Eur.

The highest amount of damage, done to CHIF last year, was close to 303 thousand Eur and was identified by conducting a monitoring of day surgery, outpatient surgery, day hospital, monitoring and emergency aid services.

Compared to 2020, much greater damage was identified after conducting the assessment of the validity of prescription of reimbursed orthopaedic technical measures (increasing to 58.3 thousand from 11.6 thousand) and the validity of the prescription of covered medicines and medical aids (increasing to 6.1 thousand from 2.6 thousand).

It was also established that last year healthcare institutions providing CHIF-covered services demanded and received unjustified payments from the patients. The total amount of unjustified payments, made by the patients, was more than 36 thousand Eur. The majority of these included patient contributions to assisted reproduction services. It was noted that illegal payments were recorded only at private healthcare institutions.  

Consulting economic entities and offering methodological support remains a priority of the National Health Insurance Fund. Economic entities receive consultations in person, by phone, in writing or by e-mail, during NHIF and THIF trainings, presentations, delivered at events and meetings, hosted by healthcare institutions. Information on relevant and often repeating issues is also available on the NHIF website. Last year, THIF experts provided nearly 200 thousand consultations.

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