The Health Insurance Fund recovered nearly 700,000 euros from healthcare providers last year through continuous monitoring of health insurance claims. “This control has improved partners’ awareness when billing for treatment, reducing unjustified claims,” said Jelena Kont, head of the supervision department
The Health Insurance Fund rigorously monitors the accuracy and justification of health insurance claims, reclaiming nearly 700,000 euros from healthcare providers last year.
“The Fund’s continuous control has increased partners’ awareness of billing practices and reduced unjustified claims, showing a positive trend,” said Jelena Kont, Head of the Supervision Department.
The supervision department regularly analyzes the medical bill database to verify the accuracy of invoices for healthcare services, discount prescriptions, and incapacity certificates. Last year, nearly 32,500 invoices were reviewed, identifying 3,198 unjustified claims worth 170,305 euros. The practice of allowing providers to correct errors and reuse funds has improved efficiency.
In 2022, 213 appeals and complaints led to 226 case reviews, including checks of multiple institutions. Requests for verifying incapacity for work certificates increased significantly. Out of 252 certificates checked, 72 were unjustified, resulting in claims for 19,989 euros.
Additionally, disputes regarding bills submitted through the Health Portal were processed 90 times, while activities related to prescription accuracy were checked ten times, leading to claims of 4,276 euros.
Ten targeted reviews were conducted to compare medical bills with patient records, ensuring services were accurately documented and justified.
“Supervision efforts are improving service documentation quality and billing accuracy. Many refunds stem from unintentional errors, such as coding or reporting mistakes. However, systematic fraud results in penalties, contract termination, and possible police involvement,” Kont emphasized.
