Translated material
“Nominalities” of purchases
“Nominalities” of purchases
“Important stories” about how the main suppliers of domestic ventilators turned out to be companies registered to fake people, and why hospitals massively refused their equipment
During the coronavirus pandemic, the artificial lung ventilation device (ventilator) has become one of the most valuable medical devices in the world. Its value today is measured not in any currency, but in human lives - in the literal sense of the word.
Severe COVID-19 causes pneumonia, and critically ill patients' lungs cannot inhale enough air or exhale the carbon dioxide they have built up. And then a ventilator comes to the rescue, taking over the functions of the patient’s respiratory system.
A shortage of ventilators in countries hardest hit by the coronavirus, such as Italy or Spain, has meant doctors have had to choose between suffocating patients and saving those most likely to survive (usually younger ones).
Russia also met the COVID-19 epidemic with a shortage of mechanical ventilation, which was recently acknowledged by the Minister of Industry and Trade Denis Manturov. At the same time, the head of the Ministry of Industry and Trade promised that domestic enterprises will increase the production of devices and will soon be able to provide them to all regions of Russia.
“Important Stories” decided to analyze how Russian hospitals purchased this vital equipment in the years leading up to the coronavirus epidemic, and found out:
Last year, the Russian government limited the purchase of foreign ventilators: domestic manufacturers of this equipment were primarily supposed to benefit from import substitution, but the main beneficiaries were unknown intermediary companies registered under dummies - students, construction workers, people reported missing;
The main activity of some of these companies was the maintenance and repair of vehicles, and they employed from 0 to 1 people;
these companies were connected to each other: they resold ventilators to Russian hospitals at inflated prices;
in many cases, these companies misled hospitals and supplied them with substandard equipment. That is, doctors received completely different devices than they needed for their work. This forced hospitals across the country to break contracts and massively abandon domestic ventilators.
This text “Important Stories” is published jointly with “ Novaya Gazeta ” and “ 7x7 ”
Import substitution is hazardous to health
In 2015, during a period of particular aggravation of anti-Western rhetoric on the part of the Russian authorities, the government introduced new rules on public procurement of medical goods. The decree, signed by Dmitry Medvedev, soon received the name “The Third Wheel” among experts and in the media, due to the fact that it obligated government customers to reject applications with foreign medical products if at least two applications were submitted for the same competition with products from the Eurasian Economic Union (i.e. Russia, Armenia, Belarus, Kazakhstan or Kyrgyzstan).
The government's initial list included 58 goods , but every year the list of foreign medical equipment subject to restrictions expanded. Last summer, Prime Minister Dmitry Medvedev added new items to the restrictive list, including ventilators.
This decision caused a storm of criticism both from non-profit organizations that provide assistance to people with rare diseases, and from doctors.
Back at the end of 2018, when the inclusion of ventilators in the restrictive list was only discussed and was not finally adopted, representatives of 12 charitable foundations sent an open letter to President Vladimir Putin. “The emergence of this project is extremely worrying, which will endanger the lives of tens of thousands of citizens of our country and cause significant damage to the quality and availability of medical care in Russia... Medical organizations do not purchase domestic equipment not because they ignore the Russian manufacturer, but because domestic the samples cannot compete with Western ones in terms of quality, reliability, functionality and ease of use,” said . the open letter
Opinion of the President of the Patient Defense League AlexanderSaversky
“Unfortunately, what we are taking are counter-sanction measures. They are being accepted under pressure from the domestic lobby, this is understandable. But this is a dishonest conquest of the market with all the ensuing consequences - which means they will continue to play on it dishonestly.” (Source: Business FM.) Who benefits?
One of the main beneficiaries of the restriction on the supply of foreign ventilators promoted by the Ministry of Industry and Trade was supposed to be the Ural Instrument-Making Plant (UPZ) from the Sverdlovsk region. He is part of the Rostec corporation, which is headed by Sergei Chemezov, a colleague of Vladimir Putin in the KGB and one of the most influential people in Russia. The head of the Ministry of Industry and Trade Denis Manturov is called a person close to Chemezov.
UPP produces several types of ventilators. The most famous of them is called “Aventa-M”. It was these devices that Russia, despite the shortage in its own hospitals, recently supplied to the United States as humanitarian aid.
Around the same time, the Russian government included foreign ventilators in the restrictive list, the management of the UPP began filing complaints and lawsuits in the courts, demanding to cancel the purchases of foreign ventilators that were taking place at that time.
For example, in May 2019, the UPZ filed two complaints with the Office of the Federal Antimonopoly Service (UFAS) of the Republic of Tyva against the actions of the local Ministry of Health, which was going to purchase nine ventilators for its hospitals. The UPP demanded that these purchases be cancelled, because, according to plant representatives, only one ventilator from Germany allegedly met the customer’s technical requirements.
At the same time, in his complaint to the Federal Antimonopoly Service, the director of the UPP Bulat Gainutdinov especially emphasized that “according to the currently implemented state program to promote the development of domestic production, the course towards import substitution is one of the priorities for the further development of the country.”
The Federal Antimonopoly Service rejected the plant's complaints , and then the UPP went to the arbitration court, where, among other things, it demanded to suspend the supply of German ventilators to hospitals in Tyva. But the court refused the plant .
In August 2019, the UPZ tried to cancel the purchase of 21 ventilators by hospitals in the Samara region. In his complaint, the director of the UPP again pointed out the need for import substitution and the fact that the technical requirements were written for one device (this time Swiss-made). But the Federal Antimonopoly Service for the Samara Region, as well as the court subsequently, also rejected this complaint .
In a similar scenario, the UPD tried to cancel the purchase of American ventilators to hospitals in the Udmurt Republic. with the UPP in this case And the Federal Antimonopoly Service (and later the court) even sided , but the Ministry of Health still bought foreign devices, but this time from Switzerland.
In almost all cases, customers (that is, regional medical institutions) or the Federal Antimonopoly Service, in response to demands to cancel purchases of foreign equipment, answered approximately the same thing:
hospitals must primarily consider their needs when purchasing medical equipment, so they have the right to indicate the technical characteristics of the equipment that are best suited for treating patients;
The customer requirements were not tailored to one single ventilator: other foreign analogues were also suitable, but not Russian ones.
From these same decisions of the courts and the Federal Antimonopoly Service, it becomes clear why hospitals preferred foreign equipment and why doctors and experts were so critical of the inclusion of ventilators in the restrictive list of medical products.
For example, modern foreign ventilators are suitable for both adults and newborns. And the same domestic device “Aventa-M” produced by UPP, as stated in one of the court decisions, is not suitable for newborns . Doctors also pointed this out.
“We do not have a Russian apparatus of an expert nature. I think in 60 years we will catch up with them... For example, ventilators for newborns - well, they simply don’t exist.”
Car service supplies ventilators
While the UPZ tried through the courts and the FAS to ensure that medical institutions purchased domestic devices, dubious intermediary companies appeared on the market and decided not to pay any attention to the technical requirements of hospitals.
These companies entered competitions, promised to supply equipment with the appropriate characteristics (which, as a rule, only foreign samples were suitable for), and brought domestic ventilators. And hospitals across the country had to abandon them en masse.
For example, in June last year, the Ministry of Health of the Novosibirsk Region held an auction for the purchase of 13 ventilators for a total amount of almost 26 million rubles. This equipment was intended for three regional hospitals specializing in cancer.
The auction was won by the Markson company from St. Petersburg, registered just a year earlier. At the same time, the main activity of this company is the maintenance and repair of vehicles. According to the Federal Tax Service, Markson has only one person on its staff.
The contract with this company was signed in August 2019, and already in December the Ministry of Health of the Novosibirsk Region was forced to unilaterally abandon it . The fact is that the ministry expected to receive devices with the technical characteristics it needed. And Markson supplied domestic Aventa-M devices manufactured by UPZ, which, in the customer’s opinion, did not meet these characteristics.
For the failure of this government contract, the Markson company was included in the list of unscrupulous suppliers.
Markson filed a lawsuit against the Ministry of Health of the Novosibirsk Region in the arbitration court. However, the consideration of the claim was postponed “due to the spread of coronavirus infection.”
A similar story happened in the Krasnodar region. Also in June 2019, the regional Ministry of Health held a competition for the purchase of 29 ventilators for local hospitals as part of the implementation of the regional project of the Krasnodar Territory “Fighting Cancer” for a total amount of almost 80 million rubles.
The competition was won by the same company, Markson. And again, it supplied domestic Aventa-M ventilators, and again the Ministry of Health was forced to refuse them due to the fact that the domestic device did not meet the customer’s requirements. (As a result, the ministry later purchased American ventilators.)
At the end of last year, this unknown company, Markson, turned out to be an even larger state supplier of the Aventa-M ventilator than its manufacturer, UPP. According to our calculations, the plant, part of Rostec, signed contracts last year to supply 30 ventilators to Russian hospitals. And Markson, which did not have significant assets or a sufficient number of employees - and in general the company was supposed to repair cars - signed contracts for 51 Aventa-M devices. But customers were forced to refuse 44 of them because the characteristics of the domestic device did not meet the technical requirements.
“Such cases have happened in my practice,” says Alexandra Fedorova, who worked for many years in the procurement department of a federal medical institution. — The tender documentation states one thing, but they bring something completely different. It happens that in such cases suppliers ask “let’s not argue, accept what you have.” It is clear that this is a big headache for the customer. It is necessary to correctly write a claim, contract waiver and other documents, and all this in a fairly short time. Otherwise, the customer himself may face fines. And then we need to make a new purchase.”
Packer, packer
The director and owner of Markson at the time of these purchases was 27-year-old Andrei Makaev. On one of the job sites you can find his resume, where he describes his specialty as a “packer, packer” in production. In his profile on the social network VKontakte, Makaev also does not give the impression of being the director of a company that supplies expensive medical equipment.
We sent questions to Makaev via social networks, and at first he answered them in detail and knowledgeably. “We supply the most modern equipment, and sometimes customers do not write technical specifications themselves, but publish the technical specifications of “their” suppliers,” Makaev wrote to us.
Because of this, according to Makaev, regional ministries of health broke contracts with his company for the supply of domestic ventilators.
“I don’t do this specifically, and I don’t have all the information. So I’m unlikely to be able to help you with anything.”
However, when we invited Makaev to talk on the phone to clarify some details of his story, he responded in a style unusual for him before: “I’m not specifically involved in this, and I don’t have all the information. So I’m unlikely to be able to help you with anything” (spelling and punctuation preserved).
Such an unexpected change allowed us to ask the question: “Couldn’t someone have written the answers for us instead of Makaev?” Makaev advised him to contact his “partner”, whose name he did not name, for further clarification.
But Important Stories managed to find him and talk to him. It turned out that the Markson company was not the only one associated with this “partner”: a whole network of similar ventilator supply companies formed around it.
Who's behind this?
A 22-year-old resident of St. Petersburg named Lyubava is an aspiring poetess . Not long ago, she decided to make extra money and called the phone number from the advertisement that a nominee director was required for the company.
Lyubava met a woman on the subway, and she asked her to become the nominal director and owner of her company. The stranger explained this request by saying that she wanted to retire. Lyubava agreed and on February 25, 2020, she became the director and sole owner of the Soyuz company.
As Lyubava told Important Stories, she was not involved in the actual management of the company.
By the time the young St. Petersburg poetess “headed” the company, it was already on the register of unscrupulous suppliers for breaking a government contract for the supply of three ventilators for the Oryol regional clinical hospital in 2018.
As in similar cases with the Markson company, the chief physician of the clinic refused to accept the domestic Aventa-M device from Soyuz because its characteristics did not meet the hospital’s requirements specified in the auction documentation.
In total, in 2018, the Soyuz company won tenders for the supply of 12 ventilators (8 Aventa-M devices and 4 Bellavista devices produced by the Russian company Berner Ross Medical). And hospitals refused to accept 10 of these devices.
The Soyuz and Markson companies have something else in common. They are united by a man whose name is Evgeny Zhukov: he used to be one of the founders of the Union, and he also represented Markson by proxy at FAS.
Little is known publicly about Zhukov, but companies associated with him (we counted at least 7) have been supplying ventilators to hospitals across Russia for several years. Moreover, these companies, as a rule, are registered with nominee directors and founders. In addition to the already mentioned “Soyuz” and “Markson”, for example, the companies “Comvel” are associated with Zhukov - it is “ run by relatives ” by a worker from the construction site - and “Corpus A” - its “owner” was searched for through the program “Wait for me” .
According to our calculations, companies associated with Zhukov are leaders in the number of government contracts for Aventa-M ventilators, and are among the ten largest suppliers of all ventilators in Russia (both domestic and foreign).
We contacted Zhukov by phone, and he answered our questions in detail and, surprisingly frankly.
According to Zhukov, he began supplying medical equipment many years ago with contracts with Rosrezerv (this agency stores the country's strategic reserve in case of emergencies and disasters). “We started working with hospitals, delved a little deeper into this topic, and began to get acquainted with manufacturers. And so, in the end, we focused on mechanical ventilation,” says Zhukov.
He is confident that Russian ventilators are in no way inferior to their foreign counterparts. And Russian hospitals refused to accept domestic equipment not because it was inferior, but because of the corruption component. “This is a topic more for a criminal investigation than a journalistic one,” says Zhukov. - For one simple reason. In those cases where we were suspended, where there were courts, technical specifications were “prescribed” for a specific supplier in which the hospital was interested. Well, of course, not for free. There are interested people, that’s why they do it.”
“We were simply kicked out of this market. Therefore, when you feel a potential danger, you immediately re-register as a “nominee” so that you can work later.”
At the same time, Zhukov does not hide the fact that he has to register companies as “nominees,” but, according to him, this is a forced way of protecting himself from unscrupulous customers. “If all these companies hang on me, then I will be prohibited from entering government procurement. If an organization is included in the register of unscrupulous suppliers, then both its founder and director immediately do not have the right to engage in this activity. Thus, we were simply kicked out of this market. Therefore, when you feel a potential danger, you immediately re-register as a “nominee” so that you can work later,” Zhukov admits.
There is another risk - losing dealer relationships with UPP. Zhukov met representatives of the plant at an exhibition of medical equipment in Moscow. Since then they have developed a good partnership. “Still, don’t forget: UPP is a Russian Technologies enterprise.” To get a dealership there, you need to go through a rather complicated screening. And after you go through all this, go to risky trades? Therefore, each dealer recruits subdealers - one, two, third, fifth, tenth. And the subdealer, of course, gets his share, but at the same time he takes risks when he runs into inadequate buyers.”
UPZ, according to Zhukov, not only sells equipment to his companies, but also provides the necessary support in the courts when hospitals refuse equipment.
“In many courts, they [representatives of the Criminal Investigation Department] participate with us, send their lawyers, help and advise. For some acceptances, when special difficulties are foreseen, their chief engineer comes. They give us full support,” he says.
The coronavirus epidemic has changed the attitude of hospitals towards Russian equipment, he notes. “If earlier they pushed away with their hands and feet: “We don’t need Russian, give us only foreign”, but over the last month and a half the behavior has changed. I receive 15-20 email requests a day for the supply of these very devices [Aventa-M],” he says.
Inflated prices
The emergence of intermediary companies registered as “nominees” led to the fact that the prices at which hospitals bought Russian Aventa-M ventilators increased significantly.
In 2019, UPZ General Director Bulat Gainutdinov said in an interview with a corporate newspaper that the price of the Aventa-M device in its maximum configuration is about 1.4 million rubles. His words are confirmed by the documents of the purchases we analyzed in 2019: if hospitals bought this equipment directly from the manufacturer, then the average price for one device was the same 1.4 million rubles.
Let’s compare this with the prices at which the same ventilators were sold by intermediary companies in 2019.
For example, last August Markson supplied two Aventa-M devices to hospitals in the Perm region at a price of 2.5 million rubles apiece. This is 73% more expensive than the manufacturer's price!
Or, for example, in 2018 the Soyuz company supplied the Aventa-M ventilator for the Ulan-Ude Republican Clinical Infectious Diseases Hospital for 2.2 million rubles, which is more than 50% more expensive than the price of the UPL.
Another company from St. Petersburg, Techinfo (its staff is 1 person), supplied 4 Aventa-M devices to children's clinical hospitals in the city of Ufa in 2018. The cost of one unit was 2.6 million rubles, which is 80% more expensive than the manufacturer’s price.
attention to this purchase The inspection of the Ministry of Finance of the Republic of Bashkortostan also drew . “Monitoring of the register of contracts concluded by customers showed a significant difference in the price of the contract for the supply of the Aventa-M artificial ventilation device. Thus, in violation of Article 34 of the Budget Code of the Russian Federation, the contract price turned out to be significantly higher than the average price for this equipment,” stated the report based on the results of the audit.
“Of course, there is always a dealer markup,” a large supplier of foreign ventilators tells Important Stories on condition of anonymity. — The dealer has his own risks; he can be included in the list of unscrupulous suppliers at any time. There are costs for logistics and marketing, legal support - these are also included in the dealer premium. Of course, they won’t tell you this on the record and under their own name, but the same markup includes “building relationships” with the manufacturer and hospitals.
According to the expert, the average dealer markup is about 30%: “In rare cases, 40%, but an almost double markup is already too much. I haven’t seen anything like this on the market.”
Agora lawyer Vitaly Gubenko believes that such markups on the supply of ventilators should be of interest to law enforcement agencies. “A large manufacturer hires dubious companies as dealers who sell its products at a markup of 80%? Law enforcement agencies, in my opinion, should check the personal connections of these suppliers both with customers and with the manufacturer itself. Working through personal contacts, statements of one-day accounts - law enforcement agencies have many ways to understand how the profits that intermediaries “swindle” from hospitals are distributed.”
As these numerous examples of purchases of domestic ventilators show, the main beneficiaries of the import substitution launched by the government last year were not Russian manufacturers, for whom everything was started. And not Russian hospitals, which so often refused these devices. The main beneficiaries were those same numerous intermediaries - “third, fifth, tenth subdealers” - on whose accounts the main profit from the resale of ventilators to hospitals was deposited.
At a recent meeting with the President of Russia - already in the midst of the coronavirus epidemic - the head of the Ministry of Industry and Trade Denis Manturov, who created so many advantages for domestic manufacturers of ventilators, admitted that quite recently he was ready to advocate their closure. “Thank God they didn’t,” concluded . he
And at the end of last month, the Russian government allocated 7.5 billion rubles from the reserve fund to the Ministry of Industry and Trade for the purchase of additional ventilators in order to eliminate their acute shortage in the regions of Russia. Concern Radioelectronic Technologies (KRET), which includes UPP, was appointed the only supplier of equipment.
And this batch of domestic ventilators will definitely not have competitors or refusals from hospitals. The time when it was possible to choose has already passed.
Photo in the announcement: Denis Grishkin / Press service of the Mayor and Government of Moscow