As reported by the Jelenia Góra District Prosecutor’s Office:

The indictment includes, among others, Sławomir N., then Secretary of State at the Ministry of Health, and Adam T., then Director of the Mazowieckie Regional Branch of the National Health Fund.

The charges against them concern exceeding their official powers in order to obtain financial benefits worth PLN 13.5 million for a Warsaw medical clinic. Prosecutors: The defendants’ actions enabled a series of frauds to be committed to the detriment of the clinic’s patients. The facility charged additional fees for cataract-removal procedures even though they were fully financed by the National Health Fund. In this way, it defrauded more than 2,000 patients of nearly PLN 2.5 million. The defendants’ conduct also led to a reduction in funds for other medical services that could have been provided by other properly operating healthcare facilities.

What did the investigation establish?

Investigators:

The investigation established that in September 2013, following irregularities involving the collection from patients of unjustified fees for services fully reimbursed by the National Health Fund, the Fund terminated its contract with one of Warsaw’s medical clinics. The contract was effectively terminated and expired on 20 December 2013. Despite this, Sławomir N., Secretary of State at the Ministry of Health, took numerous unlawful actions in the clinic’s interest aimed at enabling it to continue providing medical services financed by the NFZ. Among other things, he intervened with the President of the National Health Fund and Adam T., Director of the NFZ Mazowieckie Regional Branch. He also instructed his subordinates to interpret the regulations in a way that was intended to justify continuing cooperation with the facility despite the termination of the contract.

They add:

The NFZ president, who refused to sign a new contract, was dismissed in December 2013. Adam T. yielded to pressure from Deputy Minister N. and, as director of the NFZ Mazowieckie Regional Branch, contrary to regulations, signed an annex with the Warsaw clinic on 31 December 2013 to a healthcare services contract in ophthalmology that was no longer in force at that time. The annex was signed retroactively, effective from 21 December 2013, when the previously terminated contract was coming to an end. It extended the contract’s validity until the end of 2014.

The clinic’s accused management

The indictment also includes Krzysztof R. and Agnieszka O., the clinic’s management. Prosecutors accuse them, among other things, of defrauding more than 2,000 patients:

The facility they managed imposed additional fees on patients for cataract-removal procedures, contrary to applicable regulations, totaling nearly PLN 2.5 million. Company representatives informed patients that lenses from the company they offered, implanted as part of cataract-removal procedures, were not reimbursed and required an additional payment of PLN 600 or PLN 1,500, depending on the model. In reality, these services were fully financed by the NFZ. Moreover, contrary to their assurances, the additionally paid lenses did not have the properties they claimed, and their average price was in fact lower than the estimated lens price established by the NFZ and the Polish Ophthalmological Society for cataract-removal procedures.

The remaining charges against them concern fraud to the detriment of the NFZ Mazowieckie Regional Branch, as a result of which the branch suffered losses of more than PLN 7.3 million. Investigators:

In this case, clinic representatives reported false information in monthly reports to the NFZ, stating that procedures had been financed in accordance with the contract concluded with the NFZ, that is, without charges to patients. In addition, in nine cases, although the procedures had been performed as part of the clinic’s commercial activities and patients had been charged between PLN 5,000 and PLN 10,000, they were reported as having been performed entirely under the NFZ contract.

The accused face between one and as many as ten years in prison.

The Jelenia Góra District Prosecutor’s Office adds:

The investigation was launched following criminal notifications filed in 2013 by the President of the National Health Fund, the Director of the NFZ Mazowieckie Regional Branch and clinic patients. During the proceedings, extensive evidence confirming the validity of the charges in the indictment was collected in more than 3,600 pages of case files.