Scandal Oncology: The audit report rose like a phoenix, and with it all the found iniquity

Oncology Clinic / Photo: Free Press, Dragan Mitreski

Although the audit report for the Oncology Clinic is from March of this year, these days it rises like a phoenix and is updated as if it had been published for the first time. Even the Public Prosecutor's Office included the auditors in its preliminary investigation because it is investigating signs of criminal acts related to embezzlement in the Oncology Clinic. The Assembly woke up and put this item on the agenda of today's plenary session - about the audit of the Oncology Clinic, which ended in March of this year.

A number of red flags in this report suggest irregularities in the process of drug inventory and dispensing. It shows that in 2021, the Clinic sent invoices to the Health Fund for the medicines they used in the day hospital. The amount of these invoices was lower by almost 9 million denars than the amount recorded in the material records.

The second red flag of the Oncology Clinic is that it spent more money on biological therapy than was allowed by the budget and all this was done in violation of a series of laws. Then, they also sent invoices to the Health Fund for the medicines they used in the day hospital, but the invoice was for an amount lower than the actual amount (recorded in the material records) by 142 thousand euros.

"In the accounting records, there is a difference between the monthly data on drugs issued by the pharmacy and the drugs received in the organizational units of the Clinic. The inconsistency is the result of the fact that part of the biological therapy was procured on the reverse, before the conclusion of a contract for public procurement and at the time when it was received and issued, the price was not entered in the material record, which is entered after the conclusion of the contract. At the end of 2021, for the purpose of harmonizing the turnover, all the spent biological therapy from April to December was recorded in the amount of 649 million denars (10.5 million euros)," the report reads.

In this way, as the auditors state, a full, accurate and timely understanding of the receipt and issuance of biological therapy in the accounting records is not provided. This, in turn, prevents timely and complete monitoring of inventory consumption and has an impact on the accuracy of the data presented in the balance sheet.

Apart from the weaknesses to plan, implement and control how the conditional budget for biological therapies will be spent, the Clinic did not even have protocols for which patients should and who should not be connected to biological therapy. In other words, more money was spent on the purchase of biological therapy than the state approved - there was no criterion to which patients it should be applied.

"The accounting and material records of the stocks are not reconciled and they are not confirmed with the conditions after the census, and the Fund was invoiced for the cost of drugs in a day hospital in an amount lower than the recorded cost in the material records. The consumption of biological therapy in the amount of 649 million denars, which occurred from April to December 2021, was recorded at the end of the year, due to the fact that the drugs were procured on a reverse basis and no price was established for them," the report says, and it is added that this is inappropriate application of the Law on Public Procurement.

For clarification, the Oncology Clinic's drugs (biological therapy) are not on the positive list, because the positive list has not been updated since 2015. New generations of drugs for the treatment of oncological diseases are available on the market, so in order to purchase those specific drugs (biological therapy), the Ministry of Health and the Fund approved a special, so-called conditional budget for the Oncology Clinic. FZOM for biological therapy in 2021 granted the Clinic a high 481 million denars (8 million euros!).

"We performed an analysis of the method and selection of the type and volume of drugs for which the conditional budget was approved, their procurement and application to the therapy of patients, where we determined that the FZOM approves the conditional budget based on a submitted plan for a specific volume and type of health services , in which, among other things, data on the type of drug, the required quantities and the total amount for the purchase of the same are stated. We found that the Clinic's plan is not the result of proposals submitted by an expert collegium (the collegium did not meet in 2021), but was drawn up based on historical data on the amounts of drugs consumed. This condition creates risk of subjective and selective determination of drugs for which the conditional budget is approved, which is not supported by expert analysis and proposals and is not in accordance with Article 112 of the Law on Health Care", the auditors write.

Since in 2021 the expert collegium of 12 managers did not meet and decide jointly on which patient should receive biological therapy, each doctor individually decided for his patient, and then the application to the medical director to get the necessary signature. This was done without taking into account whether the Clinic has sufficient quantities of drugs to cover the needs of all patients who were prescribed the therapy.

"Not going into the medical correctness of the doctors' decision and not disputing the need to include as many patients as possible in biological therapy, we found that there is a possibility of prescribing drugs in quantities that the Clinic has not provided and for which budget funds have not been approved. The above creates a risk that biological therapy is not equally available to every patient to whom it is prescribed and is not in accordance with Article 8 and 112 of the Law on Health Care," the auditors write.

The procedure for the procurement of biological therapy on behalf and at the expense of the Clinic was carried out by the Ministry of Health, where a framework agreement was concluded with the economic operators whose offer was chosen as the most favorable, after which the Clinic concluded individual contracts for public procurement. With the inspection of the public procurement, the auditor concluded that with the contracts concluded in 2021 The clinic undertook obligations for 835 million denars, for which it had the consent of the Ministry of Health, but not of the Fund, as it should have. 

"In addition, the amount of obligations undertaken for the procurement of biological therapy represents 173 percent of the amount of the conditional compensation approved by the Fund, due to which obligations were assumed in an amount higher by 353 million denars than the amount of the approved budget funds, which is not in accordance with Article 7 paragraph 2 of the Law on budgets", say the auditors.

In 2021, biological therapy was procured in a period when the procedure for public procurement was not yet carried out by the Ministry, in the amount of 294 million denars (4 million and 800 thousand euros). Considering that for most of the biological therapy, only one economic operator has the exclusive right to sell it, it is procured on the reverse side, and the invoices are drawn up and delivered to the Clinic after the conclusion of the public procurement contracts.

"Not going into the need for continuous and timely provision of biological therapy, we found that the established method of procurement affects non-compliance with the principle of competition, which is not in accordance with Article 5 of the Law on Public Procurement," the audit report says.

The above-mentioned situations indicate weaknesses in the planning, realization and control of the conditional compensation, the legality of the action and affect the realization of its purpose.

From the list - headache


The auditors also focused on checking the inventory at the Oncology Clinic and noticed that the report on the inventory was not listed the state of stocks of drugs, reagents and medical consumables.

The clinic had not adopted a written procedure for the process of receiving, issuing, spending and recording the stock of drugs and medical consumables within the pharmacy and each organizational unit separately. The work in this area was carried out in accordance with previously established practice, and the monthly reports, on the basis of which it was recorded how much stock was consumed, were not archived, signed and approved by the responsible persons of the organizational units.

With the revision of part of the personnel files of the employees and the calculations of the paid salaries, it was determined that some of the employees are assigned to jobs that are not provided for by the regulations for the systematization of jobs. Also, according to the decisions on job assignment for part of the employees, coefficients and salary supplements are determined, which are not in accordance with those determined in the individual collective agreement of the clinic.

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