Seimas approved amendments to the Health Insurance Law, merging the National Health Insurance Fund (NHIF) and five territorial funds into a single entity from July 1, 2025. The NHIF Director will also gain authority to impose minimum sanctions on medical establishments, pharmacies, and operators violating regulations.
“The amendments to the Law on Health Insurance adopted by the Seimas will allow the National Health Insurance Fund to have stronger legal instruments to achieve stronger protection of patients and more efficient use of the Compulsory Health Insurance Fund. We hope that the new regulation will help, first of all, to prevent institutions from illegally prescribing services and receiving payment for them, profiting from patients by charging premiums and charging for services that have already been paid for, as well as to ensure a simpler and smoother recovery of illegally used funds for both patients and the Fund,” says Gytis Bendorius, Director of the NHIF.
Amendments to the Law on Health Insurance, which will enter into force in July next year, will allow the head of the NHIF to issue a written instruction to a medical institution, pharmacy or other entity for breaches of laws and regulations and to order the return of illegally received funds of the Compulsory Health Insurance Fund. And in cases where the right of a patient covered by compulsory health insurance to free healthcare services, medicines, medical aids or medical devices is violated, to return the illegally collected fee to the patient.
“We trust our contract partners and want to underline that the vast majority of them provide their services with integrity and strive to work on a level playing field. Thus, the amendments to the law introduce only minimal impact measures to encourage all institutions to behave fairly, to discourage abuse of the Compulsory Health Insurance Fund, and to allow the NHIF to protect the right of patients to receive taxpayer-funded and state-guaranteed healthcare services. Minor infringements or infringements caused by human error will not be subject to the impact measures”, notes G. Bendorius.
Decisions of the NHIF Director can be appealed against in accordance with the Law on Administrative Procedure, but it is recalled that an appeal does not suspend the execution of the decision.
