A criminal case against a surgeon, suspected of fraud and illegally obtaining material remuneration, has been sent to court. According to the investigation, patients were offered to pay for operations that should have been provided free of charge under the compulsory social health insurance system (CSHI).
WHAT THE INVESTIGATION ESTABLISHED
The Department of the Financial Monitoring Agency (FMA) for Atyrau Region has completed its investigation into the criminal case against the surgeon.
The investigation believes that in 2023–2025, while working at Family Health Clinic LLP and the clinic of Sole Trader "Kim V.", the suspect concealed from patients information about the possibility of free operations for varicose veins under the CSHI. According to the investigation, he received payment for these services into his bank accounts.
HOW THE SCHEME WORKED
According to the FMA, at the same time, information was entered into the DamuMed information system stating that patients were receiving free medical care. Based on this data, medical organisations received funding from the Social Health Insurance Fund.
Thus, the investigation claims, the same medical services were effectively paid for twice: through CSHI funds and by the patients themselves.
WHAT DAMAGE HAS BEEN IDENTIFIED
According to the investigation, the suspect illegally obtained money from 42 patients amounting to over 8 million tenge. At the same time, more than 14.8 million tenge was transferred to medical organisations for the services provided.
Furthermore, the investigation established facts of the suspect receiving monetary rewards from patients for performing his official duties.
WHAT STAGE IS THE CASE AT
A preventive measure in the form of a written undertaking not to leave the place of residence and to behave properly has been selected for the suspect.
The criminal case has been sent to court.
