COVID19: GHS to combat abuse of system by doctors

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Following accusations of financial waste and loopholes turning the General Healthcare System into a money sink, the Health Insurance Organisation (HIO) charged with running the service is tightening its grip.

The HIO is putting a lid on financial abuse by tightening controls on claims for services provided by all contractors, from specialist doctors to clinics.

Health Minister Michalis Hadjipantela and the HIO said they have gone through the data and are considering hiring an auditing company to monitor all claims submitted to the GHS.

The organisation will also change the way General Practitioners and specialist doctors are rewarded for their services.

Contracts will be tweaked, while all providers will submit their tax declaration forms to the HIO.

In its annual report to the state’s Audit Office, HIO argued that improvements had been made to clamp down on abuse and waste.

HIO said there was a decrease in the number of referrals issued by GPs and specialist doctors in 202; compensation given to doctors also recorded a decrease compared to the previous year.

Although in 2021, the number of specialist doctors increased to 1,808 from 1647 in 2020, the average fee for specialist doctors per visit decreased.

According to HIO data, the average fee per visit for specialist doctors in June 2019 was €100.23.

In December 2020, it fell to €66.30, and in December 2021, it recorded an additional decrease and fell to €61.09.

In December 2020, the specialist doctors submitted an average of 133 claims per month.

Last year, the average number of claims fell to 126. However, the highest number of claims per specialist doctor was recorded in July 2020, with 178 claims.

GPs also issued fewer referrals to specialist doctors on average in 2021, compared to 2020

In January 2020, GPs issued referrals for 68% of the visits they had received.

In December 2021, this percentage dropped to 39%, while paediatricians also issued fewer referrals dropping from 19% in January 2020 to 15% in December 2021.

Three years after its historic launch, the foundations of the GHS have been shaken by allegations of waste and abuse from providers.

Earlier in the month, auditor-general Odysseas Michaelides had weighed in, citing various documented cases of abuses by doctors.

Michaelides cited a recent report prepared by his office, which found that a specialist doctor was compensated with €870,742 in 2020 for outpatient services, while 11 specialists had an income of over €500,000.

The earnings of one individual GP for children reached €421,283, while 67 specialist doctors had annual earnings over €300,000.

He sent the findings to the police for investigation into possible criminal offences.