The Lublin branch of the National Health Fund questioned nearly 200 cases of providing one patient with two or more different medical services at the same time by various institutions. Penalties have already been imposed on 24 service providers.
The results of service coincidence control – i.e. simultaneous demonstration of services by different health care units for one patient at the same time – were presented at a press conference on Thursday in Lublin.
“Each benefit is verified by the National Health Fund. These coincidences are captured by the system, ”said Marek Sobczuk, head of the health care services department at the Lublin National Health Fund.
The simultaneous occurrence of various medical services in the same patient results from the verification of reports submitted to the National Health Fund by health care units. NFZ inspectors then check the patient’s medical documentation and also contact patients to check whether the services were actually provided.
The inspections carried out concerned the coexistence of services for the same patient in hospital treatment and outpatient specialist care in the period of the first quarter of 2013, as well as in hospital treatment, primary health care and therapeutic rehabilitation for the entire year 2012.
The National Health Fund questioned 116 cases in which one patient was hospitalized at the same time and benefited from medical advice in the field of outpatient specialist care. In most cases, the fact of providing medical advice was not recorded in the patient’s medical records or the patient himself did not confirm this visit in an interview with the NHF controller.
22 benefits, unjustified in the opinion of the National Health Fund, worth nearly PLN 69 PLN was shown in 15 hospitals, and 94 such benefits – worth over seven thousand. PLN – showed 42 outpatient specialist care units.
The audit of hospital treatment, primary health care and medical rehabilitation for the entire 2012 showed 67 medical services that were unjustly indicated in the reports to the National Health Fund. 99 percent the irregularities concern primary health care – there was no entry in the patient’s medical records about the provided medical advice or the doctor, at the request of a family member of the patient, issued prescriptions, a medical certificate or referral to a specialist, and the patient himself was in the hospital at that time.
This inspection covered only chronically ill patients (e.g. with diabetes, cardiovascular diseases) – for the services provided to them, GPs receive a capitation rate three times higher than the basic rate.
So far, the NHF has imposed penalties on 24 service providers in the total amount of PLN 22 thousand. zloty. “Currently, the audit results are still being analyzed. Service providers will either be called only to correct billing documents, or they will be subject to contractual penalties, “Sobczuk said. (PAP)
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