If you find medical services in your personal account that were not actually provided to you, you can also complain there, however, this does not always work. Muscovite Ekaterina Kochetkova also told The Insider that in December 2020, she discovered two medical notes about a medical examination, which she did not actually undergo. Both services were allegedly provided in the capital’s polyclinic number 11 – in 2015 and 2018. For two non-existent prophylactic medical examinations, the hospital billed 1387 and 1570 rubles. “I found two services in the MGFOMS application that I have nothing to do with (I generally only go to private clinics). Then I clicked to complain, now I went into the application and saw the result – apparently, one complaint was successfully contested, the second was not. “
And while the country has divided into supporters of vaccinations and “anti-virus”, enterprising administrators of clinics are already giving citizens virutal vaccinations with might and main: “There is a section on the State Services about information about the provided medical services, I looked, and there“ Vaccination was carried out ”- Ilya from Yekaterinburg is indignant. – To what technology has reached, already vaccinations are done remotely, without the participation of the patient. ”
Three million cases in a year
Thus, hospitals have been earning money for many years – since the compulsory health insurance system operates in Russia. At first, these were simply additions to the existing treatment – for example, a person was treating a fracture, and additional dressings appeared in the bill, which were not there. These accounts are paid by the Mandatory Health Insurance Fund (MHIF), which is replenished from employers’ funds, as well as from the budget, and therefore from taxes.
Back in 2017, the All-Russian Union of Insurers calculated that insurance companies operating in the compulsory medical insurance system conducted about 30 million examinations of medical care. In 3.2 million cases, registrations were found on the part of medical institutions trying to get money for services that were not provided in full or not provided at all. That is, more than every tenth officially performed medical procedure is fake.
Most often, citizens are credited with “prophylactic medical examination”, an expert from the All-Russian Union of Insurers, Ph.D., told The Insider. Sergey Shkitin:
“Up to 15–20% of the number of medical examinations carried out in one polyclinic may be services that were not actually provided. Some medical services, such as prophylactic medical examination, can be obtained a limited number of times (once every 1-3 years) and, if this service is considered received, this may limit the patient’s ability to receive medical care in the future – up to the identification of a registration. ”
Shkitin also stressed that false information can complicate the patient’s treatment, since the data is loaded into his digital profile, and the doctor who provides medical care will have incorrect information about the health condition.
“In case of detection of violations, the insured must contact his medical insurance organization. Insurance representatives will address the situation in a targeted manner and help restore the patient’s right to receive timely and high-quality medical care. “
The MHIF confirms that if citizens more actively monitor fake services and complain about them, this will help in solving the problem:
“In this situation, the patient’s citizenship is important,” says a source for The Insider at the MHIF. – It is necessary that several patients look at the State Services data on the cost of services provided to them. If the hospital bills incorrectly, financial penalties will be applied. Is it possible to submit incorrect accounts – yes, it is possible. But for each such application, an unscheduled check is carried out either by an insurance medical organization (CMO) or TFOMI. For this purpose, the Federal Compulsory Medical Insurance Fund has introduced such a service as checking the accuracy of invoices. “
However, when doctors themselves try to fight this vicious system, instead of being encouraged, they get problems. The topic of postscripts was raised, for example, by the traumatologist of the highest category Alexey Abzianidze, who, after a public critics the postscript system was dismissed. According to him, not only the heads of medical institutions are involved in these schemes, but also law enforcement agencies that cover the system, since “everyone understands that if you involve the chief doctor, he can point to higher officials, and the scandal can reach the minister.” …
The regional leadership, which depends on third-party funding, is also interested in the scheme: in December 2020, the media reported that the employees of the Lipetsk region administration asked the chief doctors to write down medical services, some of which the patients did not receive, in the reports. They explained this by the need to receive 350 million rubles from TFOMS.
“There is an interest here from the very bottom level, from the hostages of this situation – doctors, and up to the very top, up to the Minister of Health, who also needs to show the president a good report, – explains Abzianidze. – And then show the people on TV that everything is fine with us. If the doctor does not do this, he will either lose his salary, or conditions will be created for him that he will leave: an employee who does not fulfill the financial plan is inconvenient. ”
Leave a Reply