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Inter-institutional cooperation has saved thousands of euros in funds administered by health insurance funds

Date

2021 10 29

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Recently, a verdict was announced publicly by the District Court of Vilnius City, which obliged a Polish citizen to compensate health insurance funds for damage to the Compulsory Health Insurance Fund (CHIF) in excess of EUR100 thousand. The damage was caused by the treatment of fictitiously employed Polish citizens in Lithuania. The Health Insurance Fund, the civil plaintiff in this case, is pleased that the joint, consistent and principled efforts of the Lithuanian and Polish institutions have prevented the abuse and manipulation of the guarantees of the Lithuanian health system. 

Health insurance fund pay for the medical services provided to the insured with funds of the CHIF, but it is also important for the institution to protect and safeguard the public interest and to ensure that the funds used to pay for the treatment of the country's insured persons are used rationally, properly and legally. A major positive incentive for health insurance funds to carry out this work is the recent news of a judgement convicting a person for fictitious employment of 925 Polish nationals in Lithuania so that they could receive medical treatment in Poland without paying health insurance taxes by manipulating regulations of the European Parliament and the Council.

The Health Insurance Funds are pleased that the Financial Crimes Investigation Service (FCIS) and other Lithuanian and Polish institutions have successfully cooperated in identifying a complex scheme of cross-border fraud in the European Union, which was suspected more than 10 years ago.

„In 2009, Health Insurance Funds started receiving an unusually large number of applications from Polish citizens for the issuance of documents confirming that these people work in Lithuania, therefore they had the right to receive health care services in their country of residence, for which the Lithuanian Health Insurance Funds would pay. It is suspected that the recipients of these documents are likely to carry out activities of very limited scope and duration in Lithuania, and their wages are extremely low, which means that the contributions paid are also low. For example, the CHI contribution did not amount even to one euro,” says Lina Vitkauskienė, Head of the Population Service Division of the Vilnius territorial health insurance fund (THIF). 

According to L. Vitkauskienė, after paying only a few tens of cents of health insurance tax, these potentially fictitious people and their family members could receive full-fledged health care services in the country of residence (Poland) with CHIF funds, and in case of emergency aid, with the European health insurance card – also in countries with emergency health insurance. Countries of the European Union and the European Economic Area and Switzerland.

This possibility of unfair use of funds accumulated for the health care of Lithuanian insured persons was intolerable. In order to prevent such abuse, health insurance funds applied to the Prosecutor's Office, FCIS, Sodra, the State Labour Inspectorate, requesting the initiation of an inspection of companies that may employ fictitious Polish citizens.

All the relevant Lithuanian and Polish institutions defending the public interest were involved in the complex investigation process, and after a long and persistent work, the result is finally achieved these days - after the completion of the investigation, the possibility of making an additional damage of EUR 80,000 to CHIF in this way was prevented , and the already inflicted damage of EUR 120 thousand was ordered to be paid to the health care fund by the Polish citizen who organized the crime.

The judgement of the District Court of Vilnius City in this case can still be appealed, but health insurance funds hope that the funds used by fraud will be repaid to the country's CHIF budget and will be used to pay for the treatment of people fairly paying health insurance taxes.

Information of the Vilnius Territorial Health Insurance Fund 

The NHIF invites you:

Your questions are welcome by email info@vlk.lt or phone: local (8 5) 232 2222, international +370 5 232 2222.