Prague, Sept 22 (CTK) – Frauds in doctors’ surgeries annually cost 35 billion crowns from the public health insurance, daily Lidove noviny (LN) wrote on Friday.
It says some doctors, for instance, prescribe health aids that their patients will never get, for instance, they charge a tailor-made orthosis while the patient gets a cheaper standard version, or report a check-up that they do not carry out at all.
LN says “e-health,” or is a full computerisation of health care including patients’ complete electronic files, would help prevent such frauds.
Experts dealing with fraudulent practice in the health care sector estimate that 30 percent of finances are used inefficiently in the system. Deliberate frauds make up a half of this sum, Petr Vincenz, who investigated these cases as a police detective and now works for a Slovak health insurance company, told LN.
Patients can reveal such frauds if they check their e-health files. Health insurance companies could find out fraudulent practice if they followed the development in particular healthcare segments and by their own auditing doctors.
However, the e-health is not yet widely used in the Czech Republic. Moreover, seven health insurance companies operating on the Czech market do not share data on treatments and frauds, LN writes.
“Such data exchange would considerably help uncover frauds,” Jan Vomlela, from a health insurance company, said.
LN also writes that the police are now checking whether the bonuses given to hospitals for purchasing a large quantity of healthcare material can be classified as a fraud since hospitals charge the full price to health insurers and keep the money saved thanks to the discount.
LN also cites statistical data on healthcare expenditures in the Czech Republic with a population of 10.5 million.
The average health care spending per capita is some 26,470 crowns.
In 2015, the total costs of health care in the Czech Republic amounted to 353.7 billion crowns of which health insurance companies spent 234.7 billion. Czech households paid 45 billion crowns on medicines, dental and outpatient care and special health aids in 2015.
The seven health insurance companies annually spend 7.1 billion crowns on their operation.
Petr Kambersky writes in his commentary on healthcare frauds in LN that the reasons for invoicing false treatments or material so easily are both comprehensible and absurd.
Though most people would not like to hear this, one of the key reasons is that a crashing majority of all healthcare treatments are “free” or covered by health insurance and not a single crown is paid directly from the patients’ pockets, unlike in other European countries, for instance, France, Kambersky writes.
Another reason is uncomprehensible, he says, asking what prevents health insurers from sending all clients an e-mail document with the list and prices of their healthcare treatments. “This is easy and cheap, but still impossible in the Czech Republic for years,” Kambersky concludes.
