State audit uncovers financial irregularities in Kazakhstan’s mandatory social health insurance system amounting to billions of tenge

22.07.2024

Article published on the rus.azattyq.org website

A state audit of Kazakhstan’s Mandatory Social Health Insurance System (OSMS) has revealed significant financial irregularities, with double payments for medical services and fraudulent activities involving billions of tenge.

The audit uncovered that sub-contractors were charging twice for medical services, both from the Social Health Insurance Fund (FSMS) and directly from citizens. In inpatient care alone, double payments amounting to at least 1.7 billion tenge were identified, while in outpatient care, this figure reached 27.6 billion tenge.

Another irregularity uncovered was the double billing by dental clinics for anaesthesia. Although the cost of anaesthesia was already covered by the insurance, the clinics charged an additional 2.1 billion tenge from the fund.

The audit also discovered discrepancies through cross-checking data from the Ministries of Health, Internal Affairs, and Justice, which revealed that medications were being issued to citizens who had permanently moved abroad.

The chairman of the Supreme Audit Chamber stressed that the FSMS must ensure proper monitoring and control of the use of public funds, saying that this process should be “automated, not manual” and that the fund needs a “robust risk management system to monitor the quality of services, the availability of necessary facilities and equipment, and the validity of medical licences”.

Alihan Smailov, appointed as head of the Supreme Audit Chamber by President Kassym-Jomart Tokayev on 1st April, had previously served as Prime Minister for nearly two years, until February 2024.

The audit also revealed that as of March this year, 109 medical organisations in Kazakhstan had overdue debts amounting to 19 billion tenge. The Supreme Audit Chamber criticised the FSMS for not considering the financial stability of service providers when allocating funds, warning that this could impact the quality of medical care.

In Astana, an inspection of two major OSMS providers serving 179,000 people found that they lacked their own facilities and medical equipment, relying instead on hourly rentals. Some clinics were also found to be operating without the necessary licenses.

Overall, the audit identified procedural violations amounting to over 32 billion tenge, as well as poor planning and ineffective use of funds amounting to 31.1 billion tenge. The total financial losses and missed profits were estimated at 11.8 million tenge, along with 65 procedural violations and 154 other systemic deficiencies.

The Supreme Audit Chamber is forwarding cases of double billing and false claims to law enforcement agencies for further investigation.

The OSMS was introduced in Kazakhstan several years ago. Last year, the FSMS announced efforts to identify unverified medical services, such as diagnostic services provided to inpatients, attaching deceased individuals to clinics, and issuing medications to deceased individuals or those who had moved abroad.

According to official data, 16.2 million people are registered in the OSMS system, with 12 million of them in preferential categories for whom the state pays contributions. Another two million are public servants or employees of state and quasi-state organisations.

In January 2024, the Ministry of Health proposed a draft law that suggests increasing contributions to the health insurance fund.

Source: https://rus.azattyq.org/a/33046101.html