The Civil Cases Judicial Panel of the Zhetysu region examined the claim of NJC "Social Health Insurance Fund" (SHIF) against the medical organisation – LLP "Z" – for the recovery of an economic measure amount based on the results of medical service monitoring.
According to the press service of the region's courts, the Fund cited violations in the provision of medical care: 52 cases of unjustified hospitalisation of patients with diagnoses not included in the list of diseases for planned hospitalisation, as well as more than 600 cases of deviations from clinical protocols.
Initially, the claim amount was 56.3 million tenge, but was later clarified and reduced to 48.9 million tenge. The court of first instance upheld the SHIF's demands, recovering 48.9 million tenge from the LLP and 1.4 million tenge in court fees.
The defendant attempted to appeal the decision, arguing that hospitalisations were carried out through the portal in accordance with standards, and that the violations were related to a shortage of equipment and specialists. The LLP also pointed out procedural shortcomings in the monitoring — lack of notification, independent experts, and additional verification.
However, the court noted that, in accordance with the Code "On Public Health and the Healthcare System", medical organisations are obliged to provide care strictly according to standards and clinical protocols. The defendant did not provide evidence confirming the absence of violations.
The court deemed the LLP's arguments unfounded, stating that the Ministry of Health's conclusion, which the defendant referred to, is not binding and cannot be considered admissible evidence.
Ultimately, the court concluded that the Fund acted within its authority and had the right to apply the economic measure. The court's decision was left unchanged, and the ruling has entered into legal force.
Recall that in March it was reported that dental clinics in Kazakhstan and the SHIF had entered into a legal dispute over the payment for anaesthesia services during dental treatment.
Later, the Fund conducted an unscheduled monitoring of the quality of medical service provision and identified various violations in 238 out of 1.4 thousand inspected medical organisations.