The MLA lost in 2015 30.5 bln In audit chamber believe that the money went to pay for medical services, and intermediaries — insurance organizations that interact with hospitals and clinics, follow the volumes, terms and quality of medical services to insured citizens. To such conclusion the auditors come on the basis of monitoring results “Assessment of efficiency of activity of the insurance medical organizations as participants of compulsory health insurance in 2014-2015, and past period of 2016”.
The report notes that, according to the Central Bank, in Russia, there are 56 such insurance companies, among them “ROSNO-MS” “Ingosstrah-M” and “Spassky gate-M”.
The insurers do not fulfill their duty to protect the interests of their clients, the experts of the accounting chamber. In their opinion, is reflected in the fact that recently the number of requests for consultation assistance in the insurance sedcurity decreased by 32%. “In 2015, for advice on provision of medical care addressed, only 21 thousand people”, — said the Chairman of the accounts chamber Tatyana Golikova..
While insurers have deposited a substantial amount of funds intended for payment of medical assistance. On the activities of insurance companies can now be allocated up to 2% of MHI funds, and most of their functions duplicate the responsibilities of regional funds put in the chamber. On this basis, the auditors suggested that the Ministry of health and the Federal mandatory medical insurance Fund that the law be amended so that the territorial MHI funds were able to perform the function of the insurer.
The chamber paid attention to saving intermediaries of budget FOMS, says the President of the Interregional Union of medical insurers Dmitry Kuznetsov. According to the Union, insurance in 2015 got not of 30.5 billion rubles, and 15.1 billion rubles At the same time they returned to the HIF in 2015 67,4 billion rubles These funds were saved by identifying the insurers of errors and fraud on the part of medical institutions: hospitals and clinics attributed to citizens services and advice that was not available to them to get them for a fee from the HIF, says Kuznetsov. After identifying such a scheme, the money for unused services back in the budget, and the medical facility pays the fine, part of which goes to the HIF.
At the end of 2015 the auditors also presented the results of the validation activities of insurers. Then the chamber came to the conclusion that health insurance companies spent from the budget of HIF for 2014 and part of 2015 to 50 billion rubles.