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Audit accuses HIO of violating law and philosophy of Gesy

Auditor general Odysseas Michaelides on Thursday accused the health insurance organisation (HIO) of violating the law and philosophy of Gesy, charges quickly denied by the HIO which insisted that it was fully compliant.

Michaelides said he had asked the attorney-general to investigate possible criminal offences, but has not yet received a reply

The exchange took place in the House watchdog committee which was investigating why some private hospitals which offer services to Gesy patients have not included their A&E departments.

Michaelides was echoed by Edek leader Marinos Sizopoulos, a vocal critic of the way Gesy operates, who had taken the issue to the committee for discussion.

The auditor general said there were blatant problems with the contracts signed by the HIO with private hospitals.

And he spoke of cases where doctors not contracted with Gesy work at hospitals which have joined the system, offer their services to Gesy patients and are paid by the system, even though this was prohibited by law.

But HIO general manager Athos Tsinontides denied any laws were being broken. The HIO was operating within the law, and was paying for a packet of services to private hospitals which had joined Gesy on the basis of specific agreements.  This position was backed by private lawyers, he added.

The committee also heard that the HIO was denying access to the commissioner responsible for monitoring Gesy to the IT system. One official said that some cases needed to be monitored immediately, and the commissioner’s office could not wait for data to be made available three months down the road.

Tsinontides countered that the commissioner’s job was to check on patients’ complaints, not the system as a whole, adding that an employee supplied all information requested.

Regarding the A&Es of private hospitals, he said the HIO had spoken to four private hospitals with A&E wards, but only one in Limassol had accepted the HIO’s offer.

One in Paphos had indicated it wanted to operate within Gesy, while consultations were at an advanced stage with two private hospitals, one each in Nicosia and Larnaca.

It has been decided that private hospitals must join the system as a whole, or operate outside Gesy, he added.

Asked by journalists about waiting lists, he said that as a result of Gesy the number of specialist doctors that the public can be referred to has tripled. Numbers were such so as not to justify delays.

The HIO was carrying out checks on referrals from personal doctors and visits to specialists to see if there is abuse and unnecessary use of Gesy resources at the expense of those who really need it.

Speaking to the media after the hearing, Sizopoulos blasted the HIO, saying the discussion on the A&E wards had brought to light that it was violating the law through selective implementation. This was not only a criminal offence but meant lower quality health services for patients who are also denied the right to choose their hospital.

Sizopoulos added that doctors not part of the system are being paid for services to Gesy patients at private hospitals also not part of the system. The Edek leader added that huge waiting lists have been created especially for endocrinologists and pulmonologists who are part of Gesy with requests for appointments made in October being offered slots in May, 2022, meaning that patients have to pay out of pocket for non-Gesy doctors, medicine and tests.

Disy MP Savia Orphanides stressed that all should act within the law. “As the HIO and the health ministry have clearly stated that the issue must be regulated following the legal opinion of the attorney general, we will wait for the legislation that will regulate this issue for the private hospitals so that there is no conflict with the law,” she said.

Moreover, Disy expected the conclusion of talks between the HIO and private hospitals to include their A&E in Gesy “as we cannot have a private hospital within Gesy, without its A&E not being in Gesy.”

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