11 suspects in probe of double-billed eye surgeries; Health Insurance Fund suffers €1.7M loss
Private clinic with Turkish capital is accused of charging both the Health Insurance Fund and patients for the same eye operations, affecting 3,000–4,000 people.
Eleven people have been indicted and eight detained in a criminal probe into illegal practices tied to eye surgeries at a private hospital contracted with the Health Insurance Fund (FZO). Between 3,000 and 4,000 patients are believed to have been affected after the clinic allegedly billed the same services both to the Fund and to patients.
Extent of the scheme and financial damage
Authorities say the private hospital, which has Turkish capital, collected payments from the FZO and separately charged patients. The Fund’s budget was harmed by about €1.7 million in payments for fictitious invoices, plus roughly €8,500 in unpaid contractual fines. Investigators suspect the clinic gained an unlawful financial benefit of about €4.25 million in the period 2022–2025, and that funds paid by the FZO were used for salaries, purchases and other disbursements.
Two former directors of the Fund, one of them Den Donchev, are being investigated for allegedly signing a contract in 2020 with a representative of the private health provider in violation of prescribed procedures and the Fund’s internal rules. The criminal charges brought include abuse of office, negligent performance of duty, falsifying or destroying business records, official fraud and money laundering.
The Ministry of Internal Affairs (MIA) said: "Under the contract, by entering false data into the Fund's electronic system and preparing invoices with false content, the health institution allegedly charged the same services both to the Fund and to patients. Patients, in addition to the statutory co-payment, were also charged a private price for the operations, while it was concealed from them that the services were also billed to the Fund."
As part of the probe, searches were carried out at several locations in Skopje and one site each in Tetovo and Kumanovo. Authorities seized €50,000 and mobile phones. Among the suspects are the chairman of the Management Board, the director of the Control Sector, two heads from the Fund, an Albanian national and a company.
Health Minister Sasho Klekovski said he initiated the inquiry while he was leading the Fund. He commented: "Yes, I was the initiator of the investigation, because this concerns a health institution that had repetitive offenses for years. So not once, twice, three times, but a constant repetition of similar offenses for which it was not properly punished. I proposed to the Sanctions Commission and it accepted to terminate the contract with that health institution in order to stop the chain of impunity."
Photo: press material from the event
