6 April 2023
Ombudsman Diana Kovacheva has referred to Prosecutor General Ivan Geshev, Caretaker Minister of Health Dr. Asen Medzhidiev and Acting National Health Insurance Fund (NHIF) Governor Dr. Yordanka Penkova in relation to a journalistic investigation and complaints about breaches of the right of patients with oncological diseases compromising their treatment.
The matter concerns Valya Ahchieva’s investigation “The Guide Book: Trading in Death?” which reveals a vicious scheme of not using expensive medication for people with oncological diseases and the lack of effective control with respect to which the Ombudsman demands inspections.
“The possibility for an expensive medicinal product to be used for a patient and for the payment made for it by the National Health Insurance Fund to be reported more than once in the Medication Verification System without any monitoring or action taken by the control authorities creates actual prerequisites for medicinal products not to be used in practice which is not simply a flagrant violation of the citizens’ rights as patients and health insured persons but could also result in bodily injury or death,” the Ombudsman notes.
Prof. Kovacheva emphasises the significance of the claims made because they concern a specially vulnerable group such as patients with oncological diseases for whom the timely and effective treatment is critical.
“In addition to the specific case with the medicinal product which is at the core of the journalistic investigation, the lack of effective control gives rise to reasonable concerns that the case described in the program is not isolated and the scheme is applied for other expensive medicinal products which would bring about exceptionally adverse consequences in the health sphere of an unlimited number of people,” Diana Kovacheva adds.
She emphasises that if a life-saving medicine is not used for a person with an oncological disease or if the person’s treatment is suspended or not completed in line with the doctor’s instructions, there is an actual risk for a fatal outcome for that person.
Prof. Kovacheva brings to the attention of the Health Minister and the Acting NHIF Governor that this also harms the interests of the NHIF and the rights of health insured persons because of the use of NHIF budget funds to pay for activities which have not been performed in practice.
“I believe that, in the capacity of a financial authority whose main task is to implement and administer the mandatory health insurance in Bulgaria as regards the management of the funds collected and the payment for the health activities used and for medication to the benefit of health insured persons, the NHIF must have and apply an effective mechanism to control contractors – contractual partners, including the actual use of the expensive medicinal products paid by it,” the Ombudsman continues in her message to the health authorities. She insists that when omissions and violations are found, the measures laid down in the regulatory framework need to be applied and, if necessary, other authorities need to be involved.
“I also expect that, in a short term, actions will be discussed and taken to ensure effective monitoring and control of the use of medicinal products, including to impose effective, proportionate and preventive sanctions on perpetrators. I believe that it is imperative to guarantee the mandatory introduction of serial numbers of medicinal products in the verification system to which the NHIF will have access and will exercise timely and effective control; this will do away with the possibility that the NHIF may pay for activities which are not performed in practice and, at the same time and most importantly, this will protect the rights of patients and their access to treatment,” the Ombudsman goes on to emphasise in her letter to the MH and the NHIF.