There is a record, but there is no pain

How doctors with the help of postscribes deceive insurers: personal experience

In mid -January, the Moscow City Hall announced the opening of electronic medical records for the residents of the capital. The media report that in a month more than 190 thousand people were able to see the notes in their medical card. Not all Muscovites have access to medical records, but many of those who were able to check them found that insurance companies have to pay for their health much more than they have “painted”.

On the first of February, medical officials were forced to comment on the opened posts.

The audience was reassured, the evil is inevitable so far, but it will be eradicated in a year or two, when electronic medical cards will not only earn all over the country, but the Russians will get used to checking them.

There are cities in Russia that have introduced electronic medical records for a long time. So, in Tyumen they have been available to all residents since 2017. In St. Petersburg, an order to create electronic medical records was published in February 2018, and by summer the service became available to citizens on the Gorestrav portal. In addition, on the website of public services last year, you can request information about the medical services provided and their value. True, it is stated that information is available from September 9, 2016, and in fact it is possible to obtain information no earlier than the summer of 2018.

Strictly speaking, since 2015, when the Ministry of Health has adopted new rules for informing the insured persons, any Russian can request a full list of services rendered to him and paid from the compulsory medical insurance companies. However, the Russians did not rush to check how many hospitals and clinics earned on them. And in vain!

How to treat gingivitis

I was not too lazy to go to the gorzdrav.spb.ru portal and check the records of cases of my contacting doctors in your personal account. The first record there is dated in the spring of 2014, the latter is the end of 2019. For five and a half years, I, with a very cursory examination, found seven posts.

The first of them dates back to June 11, 2014 and looks mockingly, because it was a kind of physiotherapy session, the ideological opponent of which I have been for many years. The diagnosis of Z01.8 is another specified special examination. Surgeon Igor Gai. I went through the healing procedure supposedly in the clinic No. 39, to which I was attached at that time, but I was never fond of quartzing and UHF.

It is noteworthy that information about this service was entered in the register after 13 months - August 11, 2015, when I had no relation to this clinic, as I moved. It is even more amazing that on August 12, 2015, that is, the next day, the dentist of this clinic Olga Shargorodskaya makes an entry on the receipt of on December 18, 2014, Gingivita Services! I looked into the passport: four days before the “treatment”, I returned from a two-month trip to Southeast Asia, was pregnant, suffered from a strong toxicosis, sat in the country-even if I had gingivitis then, I would not have up to him.

It so coincided that both posts were made in August next year with a difference of a day. As if the staff was set up to urgently increase the indicators for the services rendered.

But that's not all. On June 23, 2017, the therapist Daria Kazakova from the Tyumen city clinic No. 3 recorded that three days before, on June 20, her colleague, therapist Venus Umudova, received me. The diagnosis is also interesting: Z00.8 - other general examinations. I was really attached to this clinic until 2012. But then she moved from Tyumen to Petersburg and did not visit Siberian doctors.

And in the summer of 2017, I was not in Tyumen at all.

Another postscript covers the dates from September 7 to 11, 2017 and was created by the Arkhangelsk Regional Clinical Hospital. I was not in this hospital, but in September of that year I was on Solovki where a dachshund was bitten by me. With a bite, I turned to a local hospital, there I was treated and ... ...

And further, according to the doctor Elena Grigoryeva, I spent five days in the hospital. What in reality was not and could not be.

In December 2017, I came to my clinic No. 56 in St. Petersburg for medical examination, but it turned out that I had already passed, the information about this was submitted by a certain therapist Gromov, from whom I was not treated. The instrument -the -law of the institution was a little scared, asked not to complain and gave me directions for the examinations that I could take place instead of medical examinations. In the way, I did not do which, by the way, I was not easy to walk around the cabinets without dispensary sheet.

Then I did not complain about a false medical examination, but now, seeing other postscribes, I called the territorial compulsory medical insurance fund. There, for starters, they began to request a certificate of paid services in the insurance company and monitor it with information directly on the public services website, where information about the expenses on compulsory medical insurance is submitted, and selectively. And after that, write an application with the requirement to conduct an audit on the facts of postscribes.

Two weeks of hospitalization

The information I received on the public services website did not bring much benefit-the information there for some reason is available only about the services rendered since the summer of 2018. I did not find data on the costs of registration there, but I found another suspicious record. In January 2019, I paid for the varicose veins with a laser,

For which I paid more than 32 thousand.

I was hospitalized on January 14, the next day I was operated on, and the 16th was already released home. True, they ordered to come after an extract two weeks later. I came - in the extract, it was honest that I was released with the world and healthy legs on the second day after the operation.

However, now I see that, by papers, I lay in the Mariinsky hospital for exactly two weeks.

This cost the compulsory medical insurance fund of 23,626.40 rubles.

In another 6,938.20 rubles. He was worth the removal of the superficial veins of the lower extremities. And here, of course, I had a reasonable question: what did I pay for officially, through the cash register, with a check, me?

In the certificate received from the Capital MS insurance company, it really seems that I had been in the hospital for two weeks, and my treatment cost the compulsory medical insurance fund of 30,928 rubles.

I also found there that in the dental clinic No. 15, on February 2, 2018, a set of services was immediately provided to me: removal of the seal, determination of oral hygiene indices, determination of periodontal indices (repeatedly), teaching the oral hygiene and the primary intake of a dentist.

It turns out that I came to the clinic just to remove the seal and learn to brush my teeth. And she left with a hole in her mouth.

Subscription to the registration

What to do if you find posts?

In the official response of the “New”, the head of the TFOMS in St. Petersburg, Alexander Kuzhel, said that the fund can conduct medical and economic control and examination and examination of the quality of medical care. The rules of compulsory medical insurance of 02/28/2019 provide for a reduction or full refusal of an insurance company to pay medical services if a medical institution during the audit could not prove the fact of the provision of the service. The insurance company or TFOMS is verified targetedly, according to specific complaints, as well as selective.

Apparently, it is not easy to prove the fact of postscript:

According to the St. Petersburg TFOMS, last year the controllers managed to identify the postscript only 0.02% of the total amount paid to the provision of medical services to Petersburgers.

The amount of postscribes is also not easy to assess, because the insurance company does not give the patient to the patient about the cost of the cost of each specific procedure on request.

It was not possible to establish the cost of my multi -day treatment after a dachshund bite, because the St. Petersburg TFOMS, according to the information of the Capital MS company, did not pay for the treatment.

To clarify the losses incurred by the insurance company from the Tyumen post, I had to reach the Tyumen Regional Department of Health. They carried out work and found that the information for payment for the Service of the Capital MS insurance company was not transferred to the Tyumen therapist, and Venus Umudov herself quit the city clinic in 2018. In Tyumen, the case of Umudova was called the mistake and failure of the system. In my opinion, it seems that the attempt of the Tyumen clinic was to receive money from the St. Petersburg insurance company, but was unsuccessful: for some reason, the insurance did not transfer the money, or the TFEMS TFOMS “cut” this case as a suspicious itself.

The same thing, probably, happened with my long treatment in the Arkhangelsk Regional Clinical Hospital. Perhaps both cases fell into those 0.02% of confirmed posts.

Or maybe the mess just won.

As explained by the head of the public relations department of the St. Petersburg TFOMS Evgeny Laurhammer, if the insured person of medical services in another region is provided with the territorial compulsory medical insurance fund, the TFOMS of St. Petersburg, where this information is checked. If a controversial situation occurs, in the TFOMS of the region, the service sends a request for a medical examination, and on its basis, the St. Petersburg branch draws a conclusion about the feasibility of payment of the service.

In order for me to initiate a check on the facts of registration of medical services committed in city institutions and paid from the compulsory medical insurance, the Capital MS insurance company was advised to contact them with a written statement and demand a check and confirmation of medical documentation. And if in the case of the Mariinsky hospital I can prove that instead of two weeks I spent only three days on their bed, and then went to Moscow, then it will be impossible to prove gingivita treatment.

Yes, and this is unlikely to succeed with medical examination, because I learned about deceit from a paper medical record, where there was a stamp about the examinations. There were no conclusions of doctors themselves, but the same needmed clinic will always say that they were given me in their hands.

The deputy chief physician of one of the clinics, on the terms of anonymity, told the “new” that it is in the field of medical examination that are the most popular, because the clinic’s medical examination receives not only additional accruals, but also a high rating, and the number of patients covered by the dispensary reception is one of the most important criteria for assessing the quality of the clinic administration. As for nonresident postscribes, they, according to my interlocutor, is a frequent phenomenon - usually territorial funds do not just check them. If in St. Petersburg the Petersburger is attributed to the treatment of a hand fracture, theoretically experts of the insurance company or TFOMS can find it and identify a forgery. If they “treat” the hand of a resident of Udmurtia or the Khabarovsk Territory, most likely there will be no checks. Although, as you can see on my example, and there are malfunctions here, the system also catches such postscribes.

On Facebook, one of my readers from Moscow said that he found data on six examinations of the FGDS in his medical card - the people are called "gut to swallow." One woman was surprised to find that in two years she had a nine times her therapist with an unspecified diagnosis. Nadezhda from Moscow found out that several years ago she passed the medical examination and mammography. The Petersburger Maxim, removing the tooth, read in an electronic medical card that he was attributed to this tooth multiple anesthesia. Julia from Moscow said that she had come to her mail with a request to evaluate the reception from the therapist, to whom she did not write down. Lyudmila from St. Petersburg checked her card and found out what was in the process of undergoing medical examination.

There are many posts somewhere, somewhere there are few. So, in December last year, the Yekaterinburg portal 66.ru asked his readers to check the medical records, readers revealed 30 posts. It is quite, what is called, a child: they have thirty readers on all readers, and in St. Petersburg I have one-seven. There is a lot of money in the city - we are sick and sick.