Half-a-million-euro scheme dismantled: Doctors defrauded national health and social insurance funds with fake check-ups

Large-scale operation against draining of the National Health Insurance Fund

The District Prosecutor's Office in Plovdiv and the Regional Directorate of the Ministry of Interior have uncovered an organized criminal group specialized in draining funds from the budget of the National Health Insurance Fund (NHIF) and the National Social Security Institute (NSSI). The damages amount to at least half a million euros.

"The scheme operated by declaring fictitious examinations and procedures, with over 4,000 fake referrals issued," announced the supervising prosecutor, Dimitar Pehlivanov.

Details of the criminal scheme

• Organizer: A physiotherapist, manager of three rehabilitation companies.
• Method: Recruiting people who were fictitiously registered as patients without any examinations actually taking place.
• Communication: The "patients'" data was transmitted via Viber.
• Abuse: The fictitious examinations were used to refer people to specialized hospitals and sanatoriums.

Results of the investigation

So far, five people have been detained for up to 72 hours, including an orthopedist and a physiotherapist. During the large-scale operation, 12 searches were conducted and 35 witnesses were interrogated. The activities of sanatoriums are being checked for a period of one year back, including the Specialized Rehabilitation Hospital in the village of Banite.

The investigation is ongoing to determine the exact amount of wrongfully paid funds and the involvement of other persons in the scheme.