NTA audit of a private doctor – gynaecologist

Details

Following a complaint, NTA Inspectors – Auditors conducted, from June 2022 to April 2023, an audit of a private doctor – gynaecologist, operating in Thessaloniki/ Northern Greece, with the subject of unknowingly charging on the insured persons to National Organisation for Healthcare Services Provision (EOPYY) for multiple visits to his medical office, for the period from 2019 to 2022.

According to the audit, the doctor - gynecologist, during the years 2019 - 2022, in violation of the applicable provisions, made:

  1. The registration in the Electronic Prescription System of IDIKA S.A. (Social Security e-Government Center for Social Security Services) of 225 false visits to his medical office by 22 insured persons (12 for the complainant and 223 for the 21 other insured persons), as all of them denied having made such visits during their examination
  2. The diagnoses declaration in the medical records of the 22 insured persons in the IDIKA - Electronic Prescription System, which were not true as the 22 insured persons stated that they were not aware of them
  3. The preparation of the 'Visit Forms' which bear signatures that the 22 insured persons did not recognise and the submission of these to the National Organisation for Healthcare Services Provision in order to be reimbursed, as a contracted health care provider, for the services provided to the insured persons.

The audit report was forwarded to the:

  • Relevant Medical Association for disciplinary action against the doctor - gynaecologist
  • National Organisation for Healthcare Services Provision for possible further action, within the framework of the provisions in force, concerning:

(a) the scope of the audit as it was a random sample

(b) the recognition of costs incurred by the provider to the physician as the physician submitted documentation for reimbursement for health care benefits that were not actually provided; and

(c) the imposition of penalties in accordance with the applicable legislation

  • Athens Prosecutor's Office of Appeals for the criminal evaluation of the audit findings