The reluctance of many citizens or their reluctance to come into conflict with their doctor has been met recently by the efforts of the Health Insurance Organization to combat abuses and false charges in the General Health System, since even in cases where the beneficiaries admit orally that the doctor who served them did not provide them with the services for which he claims to be reimbursed by the OAY, then they hesitate to proceed with a personal and official report or confirmation. As a result, the hands of the Organization remain tied and there is no possibility for any further movement-intervention.
“These phenomena do not work for the benefit of many”, stressed, speaking to “F”, the president of the Federation of Patients' Associations of Cyprus, Marios Kouloumas, emphasizing that “GESS belongs to all of us and we have a debt, as citizens, as patients, to protect it from the few who find ways to deceive the System for their own benefit. ” We, he said, “we, as patients, must safeguard our interests and not hesitate, because if we look at the issue more broadly, protecting the few doctors or other professionals, GESS providers or even the few beneficiaries who knowingly deceive them or try to deceive the System, we operate at the expense of many, who offer us their services in the right way as professionals but also at the expense of the hundreds of thousands of patients who use with love what, as organized patients, we fought to obtain . The GESS “.
Responsibility, said Mr. Kouloumas, “also has OAY, which must further develop the control mechanisms and be constantly on the alert. It must also launch a campaign to inform and strengthen citizens so that they do not hesitate to cooperate if necessary or even to know that there is a way for them to exercise control. Beneficiaries receive information notes in our e-mail, after each use of GESS, we must study them meticulously and verify this information or report false entries-charges “.
According to information from “F”, lately – and in the context of the OAY's effort to identify professionals who in various ways seek compensation for services they have not provided – the Organization has identified at least two different trends:
– Doctors or providers of other properties, claim compensation, knowingly or unknowingly of their patients, for services they have never provided,
– Patients and doctors or other health care providers, agree to cheat the System, replacing the service that the beneficiary received and is not covered by the GESS, with another service which the OAY compensates.
Typical is the case of a doctor, who is under investigation by the OAY and has already decided to suspend the validity of his contract, until the end of the investigation. According to information from “F”, the doctor was registering in the System services, which, as orally confirmed by several of his patients, he has never offered. In particular, he demanded, in several cases, to be reimbursed by the OAY for the administration of injectable preparations, which cost several hundred euros for each patient. However, when the OAU contacted its patients via email in the ongoing investigation, some of them did not even respond and others verbally admitted that they had never received this service from the doctor, refused to answer any question in writing and by name.
In other cases – and for specific medical specialties (where doctors have the right to offer services to their patients outside GESS for specific health problems or for aesthetic purposes), a “partnership” has been established between doctors and beneficiaries, who, by common consent , “Charge” to the System the “transaction” between them (which is not covered by the GESS), recording another, non-existent, treatment, which is covered by the GESS. In these cases, the task of OAW is even more difficult, since there is no way for any intervention-correction.
Need to intensify the ongoing inspections
“GESS seems to be a victim of the few”
The results of the recent survey conducted by OAY, “show us that a percentage of 42% of the beneficiaries have not even activated their electronic file in the software of GESS”, said the president of OSAK, adding that “this is his responsibility every beneficiary should do so, but it is also the responsibility of the personal doctor, so that the account of each of his patients is activated but also correctly and fully informed, at all times “.
Through the electronic file “and the beneficiary can know at any time the entries made for his person but also the doctors can know the examinations that a patient has undergone or the medicines he has received, in order to avoid repetitions or to intervene when he deems it appropriate for the health and safety of his patient “.
“GESS seems to have fallen victim to a few, who, while living from the System, try in every way to deceive it and unfortunately we see beneficiaries who do not hesitate to deceive GESS for any reason,” he said. in “F” the general secretary of the CCCI and member of the board of directors of OAY, Marios Tsiakkis.
“We all get the services we need and watch the updates. “Whether we are providers or beneficiaries, we have a responsibility to safeguard the System, to protect the GESS, from the few who do not use it properly or exploit it in various ways,” he said.