Inspection of a Private Clinic regarding the Lawfulness of its Operation

In response to a submitted complaint, the Thessaloniki Regional Office of the National Transparency Authority's Auditors have conducted an audit at a private clinic. The primary objective of the audit is to ascertain whether the clinic is operating lawfully, with particular emphasis on its staffing levels.

Findings:

1. The clinic:

• had opened lawfully an Oncology Department that was fully equipped, even though its current operating licence did not authorise the operation of such a department. The department was managed by a single doctor, a pulmonologist specialising in lung oncology. The clinic had allocated office space to this doctor, but no written contract had been entered into between them
• had posted informational material (videos) on the website suggesting that the clinic operated an Oncology Department and possessed the necessary equipment (a biosafety cabinet for handling cytostatic/chemotherapy drugs), even though it did not hold the necessary legal authorisation. The clinic's current operating licence did not include an Oncology Department
• did not employ the doctors and heads of departments on a permanent basis, nor had it entered into written contracts with the clinic's other doctors, contrary to current legislation
• a sufficient number of nursing staff were not employed and no staff at all were employed in essential specialisms (e.g. radiographers, etc.)
• did not have an Intensive Care Unit (ICU) in operation, as required by law in accordance with the capacity specified in its licence to establish and operate the facility.

2. The private doctor, a pulmonologist specialising in lung oncology, had been operating unlawfully as the supervisor of the Oncology Department. Since 2022, he had been prescribing chemotherapy drugs to his patients from the clinic's surgery and subsequently overseeing their administration in the clinic's 'Oncology Department', whilst the clinic's staff were responsible for preparing them.

The doctor has been found to be jointly responsible for the unlawful operation of the Oncology Department at the clinic. This is because, in addition to the fact that the Department is not included in the clinic's operating licence, providing services in an unauthorised location contravenes the doctor's professional and ethical responsibilities. Furthermore, the doctor did not have a written contract with the clinic that set out the terms and conditions of their collaboration.

3. A number of patients of the aforementioned doctor were admitted to the clinic on the instructions of another doctor at the clinic for a short period of hospitalisation, with diagnoses that did not relate to any form of malignancy, whilst specific chemotherapeutic drugs were administered during this period of hospitalisation. As outlined above, the provided data to the National Organisation for the Provision of Health Services (EOPYY) for the reimbursement of the clinic's hospitalisation costs is inaccurate.
4. In 2025, the Private Clinics Inspection Committee of the relevant Region conducted an unannounced inspection of the clinic's operational standards and found that the clinic did not have the necessary nursing staff to ensure its safe operation.

The Committee's final recommendation was as follows: a) The revocation of the Certificate of Proper Operation due to the clinic's understaffing and failure to comply with its recommendations and observations; and b) following the revocation of the Certificate of Good Operation in early 2026, the permanent closure of the clinic and the withdrawal of its establishment and operating licence.

However, the Commission did not establish or mention in its relevant Report the findings arising from the NTA's audit, namely: the existence of a fully equipped 'Oncology Department', the existence of a biosafety cabinet ready for use, the online advertising of the unauthorised Oncology Department, the existence of a doctor's office with a specialism not included in the current operating licence, that the heads of departments do not provide services as salaried employees, that the collaborating doctors do not have written contracts, and the absence of an Intensive Care Unit.

5. The Directorate of Public Health and Social Care, as the competent authority, did not proceed with the permanent closure of the clinic, despite the fact that it had received a recommendation from the Committee for the permanent closure of the clinic, involving the revocation of its establishment and operating licence, and despite the fact that the revocation of the Certificate of Good Operation had already been issued in early 2026.

In the event of any omission or performance of unlawful acts by the competent authorities and the bodies involved, the appropriate channels were followed for seeking disciplinary action.

Proposals – Recommendations:

The NTA recommended:

1. that the Region, as the competent authority, should:

(a) the clinic's operations should be permanently suspended and its licence to operate revoked, considering the condition of the clinic following the last inspection by the competent Committee.

(b) impose administrative sanctions on the clinic.

(c) inform private clinics and inspection committees of their compliance with current legislation and to provide information on any obligations arising from non-compliance, by means of a relevant circular and guidelines.

2. the competent Directorate of Public Health and Social Care, should:

(a) implement the procedure outlined in Article 6 (paragraph 2) of Law 4600/2019 in a manner that is restrictive rather than expansive, in the cases that are specified and subject to the conditions established in that article. Furthermore, it is imperative that the specified time limits for compliance (or for the submission of evidence) are strictly adhered to. Once these time limits have elapsed, the procedures provided for by law must be initiated without delay.

(b) In the context of inspections of private clinics, it is important to note that Formal Declarations submitted by the clinics' administrative managers as supporting documentation should not be accepted. Instead, the requirement is to request the submission of the documents as originally filed.

3. The private clinic is to amend its website so that the information regarding the services it provides is consistent with its licence to establish and operate.

The Audit Report was forwarded to:

1. The Athens Public Prosecutor for the Court of Appeal to investigate any potential criminal liability.
2. The National Organisation for the Provision of Health Services (EOPYY) to take any necessary action regarding the accuracy of the information submitted by the clinic to EOPYY to claim reimbursement for the hospitalisation of specific patients.
3. The relevant Medical Association for consideration of disciplinary action.