Health Insurance Fund tightens inspections of contracted health providers
Inspections will focus on cases where patients may have paid for services already covered by mandatory insurance and on clear display of co‑payment rules.
The Health Insurance Fund announced on 04 November 2026 at 12:49 that it is stepping up inspections of health institutions with which it has contracts, with special emphasis on examining how services are charged and uncovering possible cases where patients were billed for services already covered by mandatory health insurance.
Focus on double billing and transparency
The Fund said the intensified checks aim to determine whether contracted providers respect their contractual obligations and legal rules, especially regarding possible double billing — situations in which payment is collected both from the Fund and from the insured person for the same health service.
"The Fund reminds that for health services provided at its expense, in contracted health institutions, insured persons are not obliged to pay additional amounts, except the legally determined co-payment with personal funds (participation), if such participation is envisaged for the specific service. This applies to health services covered by mandatory health insurance in primary, secondary and tertiary health care, in accordance with the established rights and conditions for their realization," the statement said.
Inspectors will pay particular attention to the consistency between performed and invoiced services, amounts collected from patients and compliance with rules on co-payments. The Fund stressed that providers must keep accurate records and that billing should match the services actually delivered.
"The Fund reminds that health institutions are obligated to prominently and accessibly display information on the amount of participation, in accordance with the applicable regulations, and to issue appropriate legal proof of payment for payments made. Insured persons have the right to clear information about the health services covered by the Fund, as well as about the amount they may owe as participation," the Fund added.
If irregularities are found during controls, the Fund said it will take appropriate measures within its competence under existing contracts and legal provisions. Insured persons who have information about possible unjustified charges can contact the Fund's Control Sector; their reports will be handled with respect for privacy and personal data protection. The Fund described the move as part of its commitment to uphold insured persons' rights, ensure responsible use of mandatory health insurance funds and increase accountability of contracted providers.
Photo: press material from the event
