PREVENCIJE I SANKCIJE OD PREVARA U ZDRAVSTVENOM OSIGURANJU
PREVENTION AND SANCTIONS AGAINST HEALTH INSURANCE FRAUD

Summary/Abstract: In this scientific paper, the authors present the real situation in the fight against fraud, as well as lighter and heavier forms of crime on the Serbian health insurance market, both from the point of view of patients' rights, and from the point of view of employees in healthcare institutions, and in insurance companies that supplement the state healthcare system in the sector private health insurance in accordance with domestic and international legal regulations. The authors primarily analyze the preventive work of insurance companies and all forms of medical institutions in the fight against insurance fraud, looking at legal regulations and contemporary practice in their work. Private health insurance is particularly current and subject to various forms of manipulation and irregularities in work, given the fact that the world crisis is ongoing, as well as the large number of migrants who, in order to register their stay, "have to" contract certain types of private health insurance policies, and which again are subject to different coverages offered by insurance companies and are very susceptible to various forms of abuse and illegal exploitation. State health insurance is a special segment that the authors deal with. Because in the last three decades, no clear and concrete positive developments in these fields can be seen. Every insurance company in the region keeps its records of physical and legal figures in the "bonus-malus" system of insurance policy consumption, however, there is no better solution, because a larger "body" such as the "bonus-malus" registry has not been formed at the European Union level to monitor this type of insurance, as it is brilliantly arranged for compulsory auto liability insurance policies, where "pests" are tracked for years back and punished at by concluding new insurance contracts. The authors certainly show the benefits of introducing such a system of monitoring health insurance policies at the insurance associations of the European Union and the Balkans, which would cooperate and unify the electronic data of the insured (natural and legal persons) both for state health insurance and for private health insurance, and specifically connected the Ministry of Health with all medical chambers, insurance associations of the European Union and the Balkans, with all individual members of insurance market participants, as well as all medical institutions that provide medical services (from the simplest to the most complex), and all in accordance with the valid positive legal, domestic and international regulations and sanctions governing these areas. In the second part of the scientific work, the authors deal with the rights of medical workers in relation to insurance in accordance with a special type of insurance - the general and professional liability of doctors that they perform, which is extremely susceptible to abuse, so many insurance companies in the Republic of Serbia do not sell this type of insurance. The first insurance company in the Republic of Serbia to introduce this insurance was Basler osiguranje ado Beograd, and after its collapse, the portfolio was taken over by Uniqa osiguranje ado, which sold these insurance policies as a leader, but the amount of claims paid out led them to modify this product and introduce their "bonus-malus" records of medical clients. The paper also contains examples of this type of policy that includes coverage against the civil-legal and criminal-legal liability of doctors. In the third part of the scientific paper, the authors touch upon the current affairs and challenges faced by the above-mentioned participants in health insurance, as well as the sanctions related to their work. Finally, the series of affairs that appear as the first association to an ordinary person when medical and criminal law are mentioned is also interesting, but hand on heart, we still need to look to the future in the best possible way through the tools that exist in the medical, criminal and insurance professions. extracted the best and highest quality maxim for the benefit of the future generations coming to us, and for a better tomorrow for all citizens of the Republic of Serbia and the whole world.

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