The amount paid for hospitalizations probably exceeds 7 million leva, and it does not include the costs for medical devices and medicinal products, which will be calculated additionally after the completion of the checks. This was stated by the Deputy Governor of the National Health Insurance Fund (NHIF), Prof. Momchil Mavrov, in connection with the verification of signals for incomplete or unfulfilled hospitalizations of health insured persons, the NHIF press center reported.
The data is based on a comparison between registered visits to real, land-based gaming halls and casinos, reported by the National Revenue Agency (NRA) through an identity document and the information about the beginning and end of hospitalizations in the NHIF information systems. This allows for the identification of time and personal discrepancies with a high degree of reliability.
The report covers nearly 90% of the medical institutions that have contracts with the NHIF for hospital care, excluding only the smallest hospitals with minimal patient admissions. The preliminary analysis shows a correlation between the number of hospitalizations and the number of identified discrepancies, which indicates an unfavorable phenomenon related to the behavior of a certain category of patients. The analysis also shows that there are cases in which there is no way for the patient to voluntarily leave the medical institution, since the reported clinical pathways or protocols are related to severe conditions and indications, possibly also related to intensive care, the Health Fund announced.
At this stage, the NHIF is not drawing conclusions about guilt, fraud or organized schemes. The data is grounds for initiating inspections that will clarify all the facts and circumstances of each individual case, the Treasury added.
Conclusions on violations and sanctions will be made only after the inspections are completed. The aim of the actions taken is to protect public resources and improve control with the opportunities provided by the centralization of electronic systems, emphasized Prof. Mavrov.