
"Sloboden Pechat" reveals: Tetovo Clinical Hospital – a factory for fake medical reports to drain insurance companies through traffic accidents
Around 50 people from Tetovo have pleaded guilty to fraud against insurance companies by claiming injuries in traffic accidents that they did not have. The investigation by Sloboden Pechat reveals that what they all have in common is that the claims against insurance companies are based on false medical reports, printed from one address – the Tetovo Public Health Clinical Hospital.
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Some of the accidents actually happened, but in addition to those who were actually in the cars and who actually had fractures and serious bodily injuries, there were also additional people whose main goal was to pretend to be in the accidents, to obtain false medical certificates from the Tetovo Clinical Hospital (which did happen), and then to use such false medical documentation to seek compensation from insurance companies.
It was the insurance companies that initiated the return of the money, because they noticed strange situations - an excessive number of injured people in "minor" traffic accidents. So far, according to knowledgeable sources with whom "Sloboden Pechat" spoke at the Tetovo Public Prosecutor's Office, with the admission of guilt, about 5 million denars have been returned to the coffers of the insurance companies, and there are also ongoing cases with the same modus operandi.
All 5 million denars in the various cases were paid by insurance companies to transaction accounts as "compensation" for people who were not in the accidents but played the role of victims for financial compensation.
Since they pleaded guilty in court, the proceedings ended there – that is, they were not required to explain what the network was and who was involved in it. At the Tetovo hospital, even at the suggestion of a public prosecutor, two police officers began to be on duty – to control what kind of “paratroopers” were being grafted onto the roads.
The medical reports have different contents, but the most common is the diagnosis S00, for people who probably just lent their personal data in the scheme to extract money through fraud. However, it is not known who from the Tetovo Clinical Hospital is participating in this fraud, with the exception of one doctor who has already been convicted. This is a specialist in general surgery and traumatology who issued false medical certificates to 6 people. He was sentenced in September 2024 to pay 100 daily fines. On those false medical certificates that he issued to the fake patients "for bodily injuries received in a traffic accident", he put a facsimile of another doctor from the Tetovo Hospital. Based on the false medical certificates, the six fake injured concluded agreements for non-pecuniary damage from insurance companies even though they were healthy and able-bodied.
The same general surgery specialist is suspected by the Ministry of Interior in a new criminal complaint
This week, the Tetovo State Police filed a new criminal complaint against the same general surgery specialist from the Tetovo Clinical Hospital. According to the complaint, in his capacity as a doctor at the Tetovo Clinical Center, in 2021 he created a medical report with false content about alleged bodily injuries caused in traffic accidents on behalf of two people, with the aim of obtaining compensation from insurance companies. Then, a lawyer submitted them to the insurance company for the collection of 680 thousand denars in non-pecuniary damage.
There was also an intermediary who delivered the falsified documentation to the lawyer and withdrew the money from a bank in Tetovo, deposited into the account of one of the fake injured parties. The last suspects according to this criminal complaint are two - who, despite knowing that they were not entitled to non-pecuniary compensation for traffic accidents, provided their personal data so that it could be falsified in their name, which together caused the insurance company 680 thousand denars in damages.
The documentation that "Sloboden Pechat" had access to regarding already completed court proceedings of this caliber, indicates one address for stamping these documents, and that is the Clinical Hospital Tetovo, more specifically the outpatient clinic for surgical diseases. The investigation conducted by the Tetovo Public Prosecutor's Office indicates that the State Health and Sanitary Inspectorate and the Medical Chamber were also involved.
The prosecution wanted to catch the entire network, to reveal the intermediaries, doctors, and lawyers, and the way in which the fake injured are found to give up their personal data in order to obtain false medical certificates. But the network has not been caught. However, a chilling effect has been created, because the hospital has started to be careful and the forgers have reduced their activities.
In just one case in which we had insight into two fake injuries, the Tetovo hospital's outpatient clinic issued 9 medical reports. In the court proceedings, the expert witness and head of the forensic medicine department, Dr. Ariton Rakipi determined that "if the defendants had indeed sustained these injuries – fractures, then in both cases they would have needed to be in a cast, which was not the case with these defendants."
One of the insurance companies "Triglav" received 210 thousand denars and the other 350 thousand denars on the basis of non-material damage. Both admitted in court that "they neither had serious injuries in the form of fractures, nor were they put in a cast, nor were they in the Tetovo Clinical Hospital except on the day of the accident". However, they did not explain to us who they collaborated with and who was involved in the scheme to extort money with false medical documents issued by a state hospital. This court case ended with the "confess and run" method.
"The patient is not mine, I did not write the diagnosis, the signature is not mine"
In one of the traffic accidents involving fake medical reports printed at the Tetovo Clinical Hospital and issued in the name of specialist Z.S., he claimed that the patient who withdrew 380 thousand denars from the insurance company "Triglav" was not his, he did not write the diagnosis, and the signature on the medical reports was not his.
The accident occurred on the Gostivar-Čegrane road. The vehicle "Opel Corsa" was insured against third party liability. This type of insurance is mandatory and is concluded upon registration of motor vehicles. The aim is to provide protection in the event of damage caused to third parties and objects, so that the costs that would otherwise have to be paid by the owner of the vehicle are reimbursed by the insurance company.
There were four passengers in the accident. One of them, M.M., requested compensation for third-party liability insurance from "Triglav" through a lawyer and was paid 380 thousand denars. However, M.M. was convicted of fraud and forgery, did not appear at the hearing even though he was duly summoned, and the medical documents issued to him by the Tetovo Clinical Hospital were all forged.
According to information from "Sloboden Pechat", 8 specialists from the Clinical Hospital in Tetovo have already turned to the prosecutor's office, carrying passports and showing stamps in them, to convince investigators that someone is issuing false medical certificates and writing diagnoses on their behalf while they are not at work. It has never been discovered who issued the medical reports with false content and whether he is still operating at the state hospital in Tetovo. "Sloboden Pechat" asked the current director of the Clinical Hospital in Tetovo, Dr. Agim Berisha, how the seals of the specialists are kept in the hospital he manages.
"Every doctor keeps it with them or in their office," he told us.
The State Health and Sanitary Inspectorate checked the medical documentation from the Tetovo Clinical Hospital and concluded that "in the Moj Termin system, the patient's data is unavailable and there is no data" and according to the statement of Dr. Z.S. whose signature and facsimile are on the medical documentation, it was concluded that he stated that the signature was not the doctor's, the patient was not his and the diagnosis was not written by him.
But it is an open secret that the specialist's seal is passed around among trainees and that its use is uncontrolled not only in the Tetovo Clinical Hospital, but also in numerous state public health institutions. It is obvious that the facsimiles in the Tetovo Clinical Hospital were used both to verify non-existent medical diagnoses and to extract money through insurance companies. All four medical reports thanks to which the "patient" M.M. extracted 380 thousand denars from "Triglav" were issued by the outpatient clinic for surgical diseases in the Tetovo hospital, with the abuse of the doctor Z.S.
We requested a conversation with both the director and the specialist Z.S., but were not admitted, saying they were too busy.
Strange accidents with pedestrians
In another case, two people from the Tetovo court were convicted of forgery and fraud against an insurance company, in the same way - they were pedestrians in a traffic accident, but when a check was made at "Moj Termin" in the Tetovo hospital, they were not registered. The two of them are jointly obliged to return 660 thousand denars that they acquired without basis.
For the person F.O., from the inspection of the outpatient diary, it was found that the patient visited the hospital on January 15, 2021, under the serial number 609 with a diagnosis of S00, while the doctor who performed the examination was not recorded in the note, and the report of the X-ray finding was not recorded in the outpatient diary. Also, for the person J.O., from the inspection of the outpatient diary for traffic accidents, only one visit was recorded from 15.10.2021 under the serial number 610 also with a diagnosis of S00 with a note that there is no information about the doctor who examined the patient, and in the X-ray diagnostics department, the report was not recorded in the X-ray services diary. For both persons, it is recorded that there are no electronic records in the electronic system "My Termin", the verdict states.
The State Health and Sanitary Inspectorate and the Medical Chamber of Macedonia were also involved in all court proceedings, from which the Prosecutor's Office in Tetovo requested to carry out extraordinary inspections. However, the doctors from the hospital said that someone had abused them too, that the fake medical reports from "My Termin" on the basis of which the budgets for the trip were drained were not signed by them, and where there was a facsimile, that someone had put the seal in their name. The wider network of doctors, intermediaries and possibly persons from other law enforcement agencies has not been discovered, but a "cooling off" effect has been created - the criminal group has no longer operated in Tetovo for at least the last 6 months, after the fake victims began to "fall" one by one in the courtroom, i.e. to admit guilt.
Many of these unreliable medical reports did not have signatures from doctors, or where they did, they claimed they were not theirs. We also reviewed documentation where 8 people were reported injured in a traffic accident, but the Tetovo prosecutor's office accepted only three of them as real injured. Interestingly, out of all five rejected applicants, not one called to ask why they were not listed as injured, and none were available on their mobile phones.
-In a car accident that actually happened, with two people injured, five more people who were not in the accident at all are involved, say our knowledgeable sources who participated in the investigations.
The scheme became suspicious to law enforcement, as they began receiving many cases with an excessive number of injured people, and the conditions of the vehicles did not match the “severe fractures” reported by the injured. In other words, the cars were merely “knocked up,” and the injured had severe contusions.
Reports from expert reports on vehicles involved in several traffic accidents that are suspected of being faked are also awaited. Law enforcement agencies are becoming increasingly aware that there is a network operating in this field, so while in the past cases involving traffic accidents were processed in a short time, now "four eyes" are being opened - expert reports are being conducted, medical documentation is being reviewed in detail, and doctors are being summoned for questioning.
Because of this, resistance began to build in the hospital, i.e. a doctor would rather perform an operation than examine someone who came to him from an alleged traffic accident. Some of the injured parties, however, in an interview with a prosecutor, claimed that they really had a traffic accident, but were neither seriously injured nor wanted compensation, and they do not understand why such medical documents were issued for them by the hospital when they were sent home only with "bedoxin" to calm them down.
Insurance companies, on the other hand, are increasingly demanding that the State Health and Sanitary Inspectorate check the medical documentation submitted for compensation and do not pay out money in advance without checking.
Among these 50 convicted persons with false medical reports, there are also those who are not registered in "My Appointment" and who have undergone a bunch of examinations shown on documents from the Tetovo hospital with false content.
In one case, as many as 13 people who lied about being injured in traffic accidents pleaded guilty, and the doctor who appeared on the fake medical documents from the Tetovo Clinical Hospital stated that he did not work with fractures and did not use his facsimile in the traumatology department.
The State Health and Sanitary Inspectorate also determined that the injuries did not exist in the accident logbook that is mandatory in the hospital. This crime is not easily recognizable, which was the reason why insurance companies had no problem concluding agreements thinking that they were dealing with real injured people in traffic accidents. However, when they started the checks, they encountered banal situations – either the “injured” were not in “My Termin”, or they were not recorded in the logs, or they were registered with a completely different, easier diagnosis, and the medical documentation was not issued by the doctors who were written to have issued it.