The Audit Service's Report on OAI on "Management Audit of the Health Insurance Organisation"
In its conclusions the Audit Service notes the following:
a. We have not identified any aspects of the legislation for which to recommend amendments, although this does not mean that, with the long-standing implementation of the legislation, there will not be scope for further improvements to it. We have, however, found, as we explain in paragraphs 4.1 and 4.2 above, that the OAI is itself violating and is complicit in the violation of provisions of the GHS Act by health care providers (physicians and private nursing homes), while violating the provisions of the Balanced and Comprehensive Budget Act.[BRP]b The way in which the contracts concluded by OAI with health care providers are implemented does not ensure that OAI's financial resources are allocated in an optimal manner so as to achieve their utilization[BR]in a cost-effective, efficient and effective manner.
On the contrary, we have found that:[BR][BR] The agreements entered into by OAI, with health care providers, allow them to make excess profits, which in some cases can be described as obscenity.
The controls carried out by the SHI allow and sustain abuses, both because of the very low frequency of effective controls and the almost total absence of dissuasive penalties against those who break the law or abuse the system.
c. The sustainability of the SHI is ensured as long as the State, even illegally, covers its deficits. This, however, places a considerable burden on public finances.
d. OY's practices in its agreements with private hospitals are characterised by complete opacity and are not based on objective criteria.
e. The inadequacy of the controls carried out does not ensure the correctness of payments to health care providers.
f. There is an urgent need to strengthen without delay the public governance and internal control of the OAI
General recommendations
Almost three years after its launch, the GHS, in addition to the many positives brought about by its introduction, is becoming a source of fiscal risk to public[BR]finances and a field of serious abuses at the expense of taxpayers'[BR]money.
Our recommendations, contained in this Report, revolve around the following axes. OHA should provide all services required by the GSA Act and incur all costs associated with those services.[BRP][BRP]b. OIA should strictly comply with the GHS Act. The otherwise enforced observance of legality by any public organisation is indispensable for an organisation that has to curb generalised abuses.[BR][C] OIA should realise that the abuses concern OIA itself.[BR] [C] OIA should realise that the abuses concern OIA itself. The position publicly expressed by the OAS that, because of the Global Budget, abuses by one provider relate to other providers in the same category and not to the OAS, is the root source of the problem of the non-decisive crackdown on abuses. To this end, controls should be intensified and deterrent penalties should be imposed.
d. TheOIA should balance its Budget, starting with the 2022 Budget. If it fails to do so, it must be enforced, through the approval of its Budget, by the Council of Ministers and the House of Representatives
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