Insurance companies spent only 53% of state health insurance finances
23 June, 2011
Insurance companies spent only 53% of state health  insurance finances

Ten private insurance companies providing the state-supported health insurance programs for socially vulnerable and poor people spent only 53% of finances earmarked by the state budget.

Chamber of Control of Georgia (CCG) goes ahead with auditing the health-insurance sphere. The first audit in the past February revealed that ten insurance companies participating in the state-supported health insurance programs enjoyed about 60% profit margin on expense of low awareness of program beneficiaries and violation of consumers’ right. As a result only one-fifth

of the insured beneficiaries including poor and socially vulnerable people enjoyed the health insurance that seemed suspicious to the audit and several top officials of insurance companies and health-care ministry were arrested.

On June 14, 2011 Giorgi Alasania, Head of Audit Department of CCG, provided with results of a follow up audit of state insurance programs in 2008-2010. According to audit result, within the insurance program for the poor GEL 311.3 million were received by the insurance companies and only GEL 164.5 million were spent for the coverage of health services of the insured that translates into 53% of the total program budget.

Annually, out of 808 thousand of insured low-income citizens only 13.8% benefited from the insurance services; 45.1% of reimbursed insurance doesn’t exceed GEL 20. Therefore, only 10 % of insured could benefit from the actual financial risks insurance. Insurance agreements with 75% of insured haven’t been formed on time by the insurance companies that makes impossible to identify 13.4 thousand of citizens in the insurance database. 91 employees of social services (430 with the family member) are insured under the program, and the sums spent on them amounted to GEL 109.9 thousand. GEL 3.7 million was illegally spent on 17.7 thousands of citizens who passed away or lost their citizenship. 3.743 citizens are registered twice in the insurance database and GEL 145.2 thousand additionally spent on their insurance.

3.255 thousand of the questioned beneficiaries are simultaneously benefitting from the insurance of Ministry of Defence of Georgia, and 3.183 of them are insured under the Ministry of Education and Science Insurance Program for Teachers. GEL1.13 million was spent additionally on their double insurance registration.

On the basis of the carried out audit by the CCG, following subsequent response of the law enforcement bodies, GEL 12 million was returned to the state budget by the insurance companies.

“The CCG continues to carry out the monitoring over the implementation of the activities of the relevant institutions in order to eradicate violations detected in the state insurance field and in order to improve the management of the programs,” Alasania said.

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