In 2012, executives from Turkey's Social Security Institution announced a new online system would bring transparency.
A year later, a system called MEDULA was introduced to track all health services covered by social security. The system would be used by the state to instantly identify wrongdoings.
Yet this costly system has only fueled further corruption. A report published by Turkey's Court of Accounts last September revealed SGK embezzled millions of lira.
The Court's first finding was that general check-ups have not been billed in accordance with the Health Practices Decree (SUT). According to the Court, it is clear that SGK cannot cover check up examinations.
But the same Court determined that in 2018 different health institutions billed such check-ups to SGK. Certain health facilities appear to have billed the SGK for check-ups of over 150 patients on general surgery, chest diseases, cardiac and vein surgery, physical therapy, rehabilitation, eye diseases and cardiology.
Annually, this cost SGK 35 million 385 thousand lira. This amount was paid to private hospitals illegally.
Birth Bills for Vertigo Patients
What is more, the Court of Accounts says the information relating to the diagnoses and surgery of patients does not match billed transactions. At times, the patients' diagnoses and treatments are completely unrelated to the SGK billings.
For instance, some patients diagnosed with vertigo or upper respiratory infections were billed for c-section or natural birth. The Court of Accounts maintains that upon individual examination, no such births can be found. Still, private hospitals billed SGK for expensive birth operations in order to gain illegal profit.
One of the most common embezzlement methods involves surgery tools. The bills of some operations are largely inconsistent with the tools used in surgery. One case shows 48 Femoral Stems were used for an orthopedic operation which required one such stem. While one piece of equipment costs 2,215 TL on average, the institution received 106 thousand lira for one surgery.
Another example reveals a case where 48 knee tibial components were billed though only two of these components had been used. In other words, what was supposed to cost 1,378 lira actually cost 66 thousand lira. When these cases are added together, it seems like the SGK paid 950 thousand lira when it should have spent 21 thousand. And that is just for what was reported, the overall amount of the theft is counted in millions.
The Court of Account's report also demonstrates private hospitals excel at treating the deceased. An article in the report shows that 411 insured people were billed 956 thousand lira after their death in 2018.
Doctors on Leave Performing Surgery
Another scam often employed by private hospitals has to do with billing treatments conducted by doctors on leave.
is . Court says many doctors working at private hospitals seem to have performed surgeries when they were away due to sickness, birth or other temporary reasons. SGK was billed 2 million 634 thousand lira using this method. Same goes for doctors on yearly leave. Bills for doctors on yearly holiday amounts to 3 million 742 thousand.
Another common way of theft is cancer diagnosis. According to law, state hospitals have to list oncology PET services in their 'global budget system'. A budget ceiling is primarily determined and state hospitals offer PET services within the budget, with no limit to number of services. SGK pays state hospitals according to this budget.
However, Court report shows that PET transactions were also simultaneously billed through private health institutions. A transaction chosen for inspection clearly shows how SGK was cheated using this method. Some figures in the report are very striking: 4 thousand 424 patients who started treatment at oncology units of state hospitals started the same treatment at private hospitals within 10 days and records at these hospitals only show their preliminary examinations. This way, both state hospitals and private hospitals were paid for same transactions.
A similar scheme is used in physiotherapy. For private health facilities with SGK deals, law states: "For a physiotherapy and rehabilitation expert doctor and physiotherapist; at most 8 patients for treatments in group A, at most 16 patients in groups A and B can be billed daily to SGK. Additionally, at most 32 patients in groups C and 64 in groups C and D can be billed daily."
However, we understand from the report that these rules have been outright violated. For instance; even though patient number limit for Group A treatments is 16, SGK have been billed for 417 in Group A, 976 for Groups A and B and 1608 for groups C and D, daily. These amount to a total number of 322 thousand 444 billings per day.
These are only the tip of the iceberg Court of Accounts could find within its yearly diminishing area of authority. However they are more than enough to have a sense of secrets going on within SGK.