After conducting 930 inspections by ILC experts last year, it became clear that public institutions illegally used more than 277,000 funds from PSDF. EUR, private – more than 358 thousand. euros. Comparing the damage determined in the PSDF with the contractual amounts of the institutions, it can be seen that the total share of the damage determined in the private institutions was 6.2 times higher as a percentage of the PSDF than in the public institutions.
The report shows that the illegally used PSDF funds were higher last year than in 2022. Significantly greater harm than in 2022 was found when controlling for nursing care, specialized outpatient services, expensive tests and procedures, and services provided by early diagnosis programs.
It was noticed that in the last two years, the most violations were detected in the provision of ambulatory nursing services at home. During the inspection of these recently very actively provided services that are very much needed by people, many and various violations are found, for example, services that were not provided for payment: a patient is treated in a hospital, but services are “provided to him at home”, one employee submits for payment 50-200 services per day, a call presented to the patient for payment as a service provided at home, etc.
Patients are illegally charged premiums for services they should receive with PSDF funds. This is especially true for day inpatient and day surgery services. For example, in the activity area of the Vilnius International Airport in 2023 the percentage of services with patient premiums in private medical institutions providing day inpatient services is 42 percent. (compared to public medical institutions – 0.5 percent); providing day surgery services – 49 percent. (compared to 5.5% in public medical institutions), but in some private medical institutions it exceeds 90%, sometimes reaching even 97%.
Last year, during scheduled control procedures at the ILC, it was found that patients unjustifiably paid more than 39,000 PLN to health care institutions that provided services paid for by the PSDF. euros. The highest number of illegal premiums was found in the provision of day surgery services. Also, patients paid unreasonably when medical specialist consultations, inpatient services, nursing and supportive treatment services, transportation services, etc. were provided.
Sickness funds are responsible for ensuring that PSDF funds, which are used to pay medical institutions for services provided, pharmacies for issued compensatory drugs, and other economic entities for various medical instruments and devices, are used legally, transparently and efficiently. Therefore, checks are carried out every year to see if health care service providers, doctors and pharmacists comply with the established requirements, if they do not comply with them – they determine the amount of illegally used funds, which the medical institutions must return. The contracts of all medical institutions with the ILC include the institution’s obligations to compensate PSDF damage, if any.
Continuous monitoring of business entities and prevention of possible violations gives good results – thanks to the consistent counseling of medical institutions, pharmacies, opticians and other business entities and monitoring of their activities by sick funds, more than 3 million were avoided last year. EUR damage to the PSDF, but the available means do not always achieve the desired effect. Seeing the growing number of non-conformities and violations every year, VLK advocates the improvement of legal regulation.
Tags: Sickness funds violations medical institutions decreasing
