site.btaPolice Exposes Health Insurance Fraud Scheme

The economic police has exposed a scheme for defrauding the National Health Insurance Fund (NHIF). In the scheme, a hospital for physical therapy claimed payments from the NHIF for fictitious medical services, said the National Police.

The scheme was uncovered during an investigation by the economic police which started December 4 together with the NHIF control bodies. The scheme is believed to have been operational from January 1, 2022 to June 30, 2023. During this period the hospital reported 5,681 hospitalizations. Some of the patients were admitted to the said hospital once but were reported for hospitalizations two or three times. The hospital also reported the hospitalization of people who were staying at hotels in the same or nearby towns and had their personal data stolen.

The value of clinical pathways that were most used in the fraud is BGN 391 and BGN 487.

The investigation continues.