Clinic under fire following Gesy system fraud

Management and doctors at a clinic operating within the national health service (Gesy) are under scrutiny by the authorities for fraudulent billing registrations.

An investigation by the health insurance organisation (HIO), likely to be aided by the police, is underway, while the HIO has proceeded to suspend the clinic’s contract – as well as those of several doctors – as Gesy providers, daily Philenews reported on Thursday.

The case came to the attention of the HIO following a tip off that surgeries had been performed by a particular Gesy doctor from a district different to the one where he was registered.

The clinic itself had previously been on the HIO radar, after one of its doctors was accused of registering medical procedures he carried out in the name of another doctor, who was not even in Cyprus.

The current case, likewise, concerns requests for compensation for services submitted to Gesy’s computerised system in a name other than that of the doctor who performed the actual service.

Specifically, surgeries were carried out by a provider at the clinic who was not contracted there, but who billed in the name of his contracted colleague practising under the same specialty.

It appears that the same tactic was followed for an anaesthesiologist, and preliminary HIO findings revealed that this health professional, who performed services, was also not registered with the clinic, but later billed for their services under another name.

The HIO has heard statements from patients who underwent the surgeries in question, which seem to confirm the initial information, according to the daily news source, as the names of the surgeon and anaesthetist who were in the operating theatre do not match the names of the providers subsequently entered into the Gesy computer billing system.

As part of the investigation, a team from the HIO and inspectors from the health ministry visited the clinic following which it was officially informed that its contract was suspended on August 4.

In their letter to the clinic, the investigators noted that it had submitted requests for reimbursement of in-hospital procedures under the names of providers contracted with the clinic while the procedures were knowingly performed by other uncontracted providers.

Other irregularities, including requests for reimbursement for inpatient services which are categorised and reimbursed as outpatient, were also noted.

The HIO also sent a letter of suspension to the surgeon in whose name the operations were falsely registered, while the doctor who carried out the operations is under investigation.

In the meantime, a physiotherapist from the clinic has also been suspended for entering reimbursement requests for services other than those provided.

Some of the allegedly involved doctors have declared ignorance of the happenings despite the fact that their names are in evidence in the initial complaint and patient reports, and are logged into the Gesy data system.

The degree to which they are implicated is expected to be clarified in due course.