Health Insurance Fund paid €1.5 million after court rulings — recipients not publicly identified
Audit: the Health Insurance Fund paid 94,209,000 denars to two plaintiffs in 2024; the recipients and the underlying claims remain undisclosed.
The State Audit Office's 2024 review found that the Health Insurance Fund (FZOM) paid 94,209,000 denars to two plaintiffs in court-ordered settlements — an amount equivalent to 1.5 million euros. The Fund has not publicly identified who received the payments or detailed the claims behind them.
The audit also shows that FZOM faces 21 pending court cases in domestic courts with total claimed amounts of 4.6 million euros. About 67 percent of that exposure — roughly 3 million euros — stems from lawsuits initiated by private health providers seeking payment for services they say exceeded their contracted annual reimbursements.
Litigation with a German hospital and other disputes
One foreign claimant, a German hospital, has brought 12 separate proceedings against FZOM demanding payment for care provided to Macedonian patients; the combined value of those claims is 433,000 euros. According to the audit, expert assessments and a legal opinion were obtained, information was forwarded to the Government and communication was opened with the hospital, but by the date of the audit no new actions or significant changes in case status had been recorded.
So far, nine of the hospital's claims have been upheld by a German court, while FZOM has appealed four of the rulings. Other lawsuits against the Fund were filed by insured citizens seeking coverage for treatment abroad, for unpaid portions of invoices for orthopedic aids, and over procurement and other contractual obligations.
At the same time, FZOM appears as plaintiff in eight court actions with a combined value of 57 million denars; 97 percent of those claims relate to demands from orthopedic suppliers for allegedly inappropriate or nonconforming aids delivered to patients.
The auditor warns that FZOM is party to procedures whose outcomes cannot be predicted and which could have an effect on the Fund's finances. The lack of public detail about the two large payments and the identities of the recipients leaves unresolved questions about transparency and potential fiscal risk.
Photo: press material from the event
