The Health Insurance Organisation (HIO) appears unable to crack down on shenanigans by physicians who are registered with the national health system, with one doctor for instance found to have billed the system for cataract surgery once every five minutes.
Lawmakers were discussing the preliminary findings of the auditor-general’s probe into the workings of the HIO and the national health system (Gesy).
The chief findings concentrated on apparent abuses within Gesy, the 37 contracts signed between the HIO and private hospitals, as well as on services that the health system ought to have offered as of this year but has not.
Auditor-general Odysseas Michaelides said the HIO is the single largest semi-governnental organisation with a €1bn budget.
The HIO is the entity tasked with implementing Gesy. In order to operate inside Gesy, individual doctors or healthcare facilities must first enter into a contract with the HIO.
Running through cases of system abuse flagged by the Audit Office, he cited an ophthalmology company – contracted with the HIO – consisting of three doctors, who in the space of seven months racked up €1.7m in billings. Of this, €1.45m went to one of the three doctors.
In another glaring instance, on certain dates a Gesy-registered doctor would bill the system once every five to six minutes for cataract surgery, each costing €1,170.
When he queried HIO officials about this, Michaelides said, their reply was: “Ok, so what?”
Also, in February 2020 a memorandum was signed between the HIO and a private healthcare facility for the second phase of Gesy – the addition of inpatient care. The memorandum was not legally vetted but was nevertheless signed off on by the minister of health and the HIO.
According to the auditor-general, the law states that remuneration procedures and means are defined by regulations; he asked why the HIO lacked these rules.
“At the very least they should have issued circulars determining the methods of remuneration…the HIO has entered into some unlawful contracts, and their answer was that ‘we had to do it if we wanted to sign contracts’.”
What’s more, the watchdog discovered that certain contract clauses refer to physicians with a provider who are not enrolled with Gesy.
“It’s implied in the memorandum that doctors of the hospital or clinic in question can participate in medical acts without them being registered with Gesy, which is an outright breach of the law,” asserted Michaelides.
He said the HIO irregularly decided to leave out of the second phase of Gesy various healthcare services that were provided for – like palliative care, rehabilitation, preventive dentistry, and transportation by ambulance in accidents and emergencies.
Addressing these criticisms, a health ministry official said the HIO did legally vet the memorandums – framework agreements – it signs with hospitals. However, the HIO opted to use their own legal consultants rather than the attorney-general.
HIO acting director Athos Tsinontides acknowledged issues with the system, but hastened to add: “There is no problem, if we do track fraud we can deal with it, but first we need to get the proper documentation.”
He said the HIO is severely understaffed – currently 100 people work there – and asked parliament to help in that regard “since we are administering the largest fund and the biggest project in the Republic of Cyprus.”
The HIO chief insisted the quality of healthcare provided has not been downgraded, meaning taxpayers are getting their money’s worth when contributing to Gesy.