site.btaPlovdiv Police Cracks Health Insurance Fund Siphoning Scheme

Police in Plovdiv uncovered a large-scale scheme to siphon off funds by using fake medical documents to receive funds from the state budget and the National Health Insurance Fund (NHIF). The fraud is related to the provision of assistive devices for people with disabilities, Plovdiv Regional Prosecutor Petar Petrov and the Interior Ministry Regional Directortate in the city, Senior Commissioner Georgi Chergov announced at a joint briefing on Wednesday. So far it has been established that 8,007 protocols have been issued in the last year, under which BGN 5.2 million have been paid. Eight people have been detained in the case, including five doctors who participated in expert commissions.

The scheme became effective in July 2022, when changes to the Medical Expertise Ordinance and its implementing regulations were adopted. These changes require persons with varying degrees of disability to undergo medical examinations to establish the need to receive aids. Then a company was established in Plovdiv, which is the principal of a medical centre based in Sofia, prosecutor Petrov said. It had four expert commissions made up of two doctors each - orthopaedic, neurological, ear, nose and throat and surgical. The manager of the centre, who started issuing protocols, owned two companies and an aids shop. The records of persons who needed these aids were procured through distributors throughout the country who visited Homes for the Aged and Homes for the Handicapped. It was found that the staff of these homes also provided their data, for which they received kickbacks.

So far, the manager's companies have been found to have absorbed BGN 815,000 under 730 protocols for examinations of persons with disabilities without their being examined. For the remaining protocols issued by the centre, it is yet to be ascertained in what manner and how the aids were disbursed. In some of the cases, people asked for sums of money in lieu of aids, which were paid to them by the centre. As an example, the prosecutor pointed out that in one of the cases, BGN 600 was transferred to a person, while the amount allocated for an aid by the NHIF was BGN 4 000..

The police operation was carried out on August 28, when 16 addresses in Plovdiv and the country were searched and a large number of documents, 50 data flash drives, about BGN 50,000, 10 computers, electronic signatures used by doctors, members of the committees were also identified, said the Director of Plovdiv Police Georgi Chergov. Seven people have been detained. The main actor, the manager of the centre, who was abroad at the time, was arrested on his return to the country.

All were detained for 72 hours. Two of the medics are from Veliko Tarnovo, the others are from Plovdiv. The doctors have been charged with document fraud and the employees of the two companies with aiding and abetting.

The pre-trial proceedings were launched in April this year after an investigation by the Economic Police and a signal from the Regional Health Inspectorate, added the supervising prosecutor Dimitar Pehlivanov. Over 500 people have been questioned in the course of the investigation. It was found that protocols were issued in the names of 27 deceased. The issuance of medical aid protocols is only 10% of the entire activity of the Medical Center, Pehlivanov said. Upon checking the addresses of the centre in Sofia and Plovdiv, investigators found that they were fictitious. No medical activity related to people's health was found there, the prosecutor added.