The ongoing investigations by the General Directorate of Anti-Money Laundering and the Prosecutor's Office into large-scale schemes with fictitious operations and "hollow" patients in major hospitals in the country have caused a wave of public outrage. For many, this seems like a new peak of impudence in domestic healthcare. However, the truth is much more cynical: this defect was embedded in the DNA of the system two decades ago.
As early as the period 2005 – 2006, when the Health Insurance Fund was still in its current model, the first scandalous signals began to leak out. Back then, in the era of paper files and the lack of any kind of connectivity, individual citizens would accidentally discover absurd facts in their files. The stories were like something out of an absurd comedy: people who had never broken a limb were found with their legs in plaster casts; healthy men found themselves "operated" for a hernia on paper while on vacation, and mothers found out that their children had "lain" for weeks in wards for severe lung infections, while they were actually attending kindergarten.
Back then, these cases were swept under the carpet as "technical errors" or "single omissions". Today we know that this was the beginning of the most profitable illegal business in the country.
The era of “phantom patients“
15 years ago, around 2010-2011, the term “phantom patients“ officially entered the vocabulary of institutions. Then, large-scale audits in hospitals in Devin, Kotel and a number of private clinics for the first time revealed the industrial scale of the fraud. The scheme has always been simple: hospitals need money, the Fund pays only for “work done“ (clinical pathways), therefore – the work is invented. Personal data was copied from old examinations, lists were bought, and people did not even suspect that they were seriously ill for the system.
In 2021, the scandal reached the top of state medicine with the revelations at the elite hospital “Lozenets“, where dozens of citizens found themselves fictitiously hospitalized for expensive and complex cardiovascular procedures.
The Great Guessing: How Many Billions of Euros Leaked?
If today – thanks to the interception of data between the NRA and the NHIF – we see how patients with documents end up in casinos, or through the “eHealth“ application citizens catch fraud in real time, the scariest question remains: What was happening over the past 20 years?
When there was no digital tracking, software interceptions and mobile notifications, NHIF control was reduced to controllers physically counting hospital beds – a mission doomed to failure.
Today, experts can only guess at the extent of the damage, but the mathematics of uncontrolled activity is ruthless:
- The NHIF's hospital budget aid grew at a breakneck pace every year – from under 500 million euros at the beginning to over 1.8 – 2 billion euros per year these days.
- If we accept the conservative estimates of industry experts that between 10% and 15% of all reported hospitalizations over the years have been “hollow“ or artificially inflated, it turns out that between 150 and 250 million euros a year have sunk into the black hole of fictitious treatment.
- Over a period of 20 years, the total amount undoubtedly exceeds several billion euros – taxpayers' money, which went neither for higher salaries for nurses, nor for modern equipment or children's hospitals, but into someone's private pockets.
Digital retaliation?
What has changed today is not the morality of the offenders, but the technology. The introduction of e-healthcare has finally put a weapon in the hands of citizens. Over 1,700 lightning reports of fake examinations and hospitalizations were filed by ordinary people in just a few months via their phones.
But while the state is ostentatiously arresting doctors and hospital managers today, the bitter taste remains. The system was left to bleed financially for two decades, and the “phantom patients“ have become the longest-kept secret of the Bulgarian transition. Now the question is whether there will be real convictions, or we will simply continue to watch another episode of the series “Drain the Coffers“.