Suspicions that realtors take seriously ill patients up to 2 euros for a false prophecy

An investigation, which was launched by the State Prosecutor's Office and was signaled by the Ministry of Health, raises suspicions that realtors of private hospitals abroad take up to 2 euros from seriously ill patients to falsify two hospital profiles to apply to the Health Insurance Fund for support. KOHA has provided communications that support these suspicions

The Administrative Instruction for Treatment Outside Public Institutions has determined the prices for 115 types of diagnoses, while for those that are outside the list, three reports from different states are required to determine the value of the expenses that are covered by the Health Insurance Fund.

In order for the money to remain with a part of the hospitals, the suspicion has been raised that realtors of private hospitals offer patients two false prophecies, so that their hospital is selected to be covered by the state. For this, the Ministry of Health has signaled the Basic Prosecutor's Office of Pristina, which has started investigations.

In the investigation file, there are evidences of the patients' communication with these realtors, in which they talk about the falsification of statements.

A fake prescription costs between 1 and 2 euros, and the burden falls on the patient. This is evidenced by a communication that the Ministry of Health handed over to the investigator, who then showed it to KOŠA.

Mediator: Is it for you? Patient: Yes. The mediator: Yes, yes, I informed him about you, now I tell him 1.000 euros to take, not 2.000, don't take it", says one of the communications provided by KOHA.

And in another communication, the mediator says that Turkish prescriptions can be issued to the patient without money, but those from other countries are paid.

"Patient: Good morning. Liver transplant... Mediator: Yes. Patient: Yes, I also need 2 invoices from different countries. Do I do it by handing it over to the ministry? Mediator: Hmmm, by God, I should send 50 to Turkey, but to other countries, they are begging, by God. On Friday I received one", the communication states.

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Regarding fraud with pro-invoices, the Health Insurance Fund has confirmed that they have sent the case to the investigator.

"Regarding the fees, which are provided by UA 03/2023 (application with 3 fees for services that are not part of the appendix), according to the Board's assessment, the Fund has requested and continues to request confirmations for each fee from the relevant health institutions. The issue of profits has been addressed to the relevant institutions", said the Health Insurance Fund.

KOHA reported a few days ago that a great suspicion has been raised about attempted abuse of the budget dedicated to the seriously ill. Some hospitals abroad have denied bills presented by patients to the Fund. And such invoices, which are suspected to be fake, appear to have been issued by hospitals in different countries, including those in China.