Romania’s Fraudulent Healthcare System

The Satu Mare Municipal Hospital

Romanians have a bipolar relationship with corruption. Conceptually, most Romanians are opposed to corruption as a concept, but only when corruption is seen as the act of siphoning money from the public realm for private benefit. This is especially true when corruption is undertaken by a nebulous “them”, a faceless group of politicians and businessmen who steal from the public purse for their own benefit. Yet the average Romanian has different considerations for acts of corruption when they are conducted to further their own interests.

Sure, slipping a little bit extra cash to the nurse to expedite tests is not truly corruption because nurses are underpaid and overworked. “Dropping” a twenty-euro bill to get out of a speeding ticket is acceptable, who wants to deal with the hassle of paying fines? Giving an expensive gift to your child’s teacher is also acceptable, it’s common courtesy even. And this whole anti-corruption crusade has surely been taken a bit too far, right? It’s all fair game when it is about “them” going behind bars for corruption, but surely it’s not our fault.

Yet there are a few areas where even in a country as morally flexible with what is OK and what isn’t in regards to everyday corruption as Romania, corruption is completely unacceptable, and one of those areas is healthcare. Two of the biggest corruption scandals in Romania were born out of issues of ineffective healthcare management, one we have written about before, and a second one that caused the street protests that toppled the Victor Ponta government in 2015. So it should be no surprise that a mounting corruption scandal involving Romania’s National Health Insurance Administration (CNAS) is gearing up to one of the biggest scandal of the year.

Romania has a single payer health system, which means that all employees contribute to the national healthcare budget and can benefit from free treatment and tests regardless of their medical condition. In theory, of course. In practice, the system is incredibly sluggish and under-performing leading a significant numbers of patients to use private healthcare services that some employers offer as perks. But it’s no wonder the state-funded system is underperforming: according to a new investigation by Romania’s Anticorruption Directorate (DNA), almost 80% of the body’s funds dedicated to home care have been siphoned off last year through fictitious contracts. CNAS’ funding is some 28 billion lei for 2017 (a sevenfold increase since 2002), or about 6,3 billion euros, meaning that the 3 million euros allegedly defrauded by CNAS’ former manager Marian Burcea and 13 other suspects currently under arrest is small change in the grand scheme of things.

According to the DNA, CNAS’ manager, Marian Burcea and his equivalent at the Bucharest level, alongside six other civil servants and department heads in the two institutions helped four companies specialised in home care monopolise the vast majority of CNAS’ funding for the home treatment of patients through fictitious contracts, contracts they would later receive a significant percentage of (10 to 20%) as kickbacks. It seems that even the head of the internal CNAS antifraud office was in on the racket, making any attempt at stopping the fraud impossible. Beyond the obvious problem of defrauding the state, this turn of events had dire consequences, as serious cases were prevented from getting the care they needed due to a major “lack of funds for home care”.

Patient organisations have long and fruitlessly petitioned the CNAS for help in making the process of home care more transparent but their efforts fell on the deaf ears of the institution’s leadership. Patients, even very sick patients, were repeatedly told off, as CNAS bigwigs pointed to their already exhausted budget — even if the fiscal year was still in its second quarter. This immoral act has led to the endangerment and, more than likely, the death of countless patients in need of care in what amounted to a grim confirmation of the 2015 Colectiv protest slogan, “Corruption Kills!”

Further outrage-inducing stories leaked to the press claim that the manager of CASMB, CNAS’ local Bucharest equivalent, specifically instructed civil servants to prioritise fraudulent files handed over by ambulance-chasing lawyers over those filled out by disabled citizens on stretchers and in wheelchairs. In the end, this nefarious scheme proved to too much to handle even for those involved. The person who blew the whistle on the deal is none other than the manager of one of the companies benefitting from the deal, who claimed she tried opening up to the authorities several times before, to no avail.

Although the scope of this ongoing investigation is limited to home-care services, there are clear signs that the corruption goes way deeper. Romanian taxpayers have the right by law to receive medical care in certain private facilities and have the state reimburse those private care institutions. Last year, the National Health Insurance Administration paid over €100 million to such private medical companies for surgeries and other medical interventions. How much of this sum was funneled through fictitious contracts is unknown, but the number of private medical institutions has exploded in the last few years. And that’s not all — lab tests reportedly swallowed up over €150 million in the same period. According to patient care advocates, the monthly budget for reimbursable tests is sometimes exhausted in the first 2–3 days of each month, something that is at least strange, if not downright suspicious.

Needless to say investigations are still ongoing, as the home care scandal seems to be merely the tip of the iceberg. While the CNAS had the leading role in 22 of the 41 major corruption cases that have been tried since 2015, this latest incident serves as a litmus test of the level of corruption present in a field where even the most jaded Romanian would agree there is no place for corruption.