NHIF paid BGN 7 million for "hospitalized" patients who were in gambling halls instead of hospitals

The National Health Insurance Fund (NHIF) paid BGN 7 million for “hospitalized” patients who were in gambling halls instead of hospitals. This was stated by the Deputy Governor of the NHIF, Prof. Momchil Mavrov.

“What we are announcing is not a sensation, but the result of a serious analysis of data provided by the National Revenue Agency (NRA). The amount paid for these hospitalizations likely exceeds BGN 7 million, and this does not include the costs for medical devices and medicinal products, which will be calculated additionally after the inspections are completed,” added Prof. Mavrov.

Preliminary analysis of data for the first half of 2025 shows over 22,000 registered visits to gambling halls made by 3,890 health-insured individuals who were reported as hospitalized at the same time.

The data is based on a comparison between registered visits to physical, land-based gambling halls and casinos reported by the NRA via identification documents and information regarding the start and end of hospitalizations in the NHIF information systems. This allows for the identification of temporal and personal discrepancies with a high degree of reliability.

The report covers nearly 90% of the healthcare facilities that have contracts with the NHIF for hospital care. Only the smallest hospitals with minimal patient flow are excluded. Preliminary analysis shows a correlation between the number of hospitalizations and the number of identified discrepancies, which indicates an unfavorable phenomenon related to the behavior of a certain category of patients. The analysis also shows cases where it would be impossible for the patient to leave the healthcare facility voluntarily, as the reported clinical pathways (CP) or clinical procedures (CPr) are related to severe conditions and indications, likely involving intensive care.

At this stage, the NHIF is not drawing conclusions regarding guilt, fraud, or organized schemes. The data serves as grounds for initiating inspections that will clarify all facts and circumstances for each individual case.

“We are talking about data that does not match and requires oversight. Conclusions regarding violations and sanctions will only be made after the inspections are completed. The goal of the actions taken is to protect public resources and improve control using the opportunities provided by the centralization of electronic systems,” emphasized Prof. Mavrov.

Due to legal restrictions and to avoid making insinuations during the inspections, the names of specific healthcare facilities are not being disclosed at this stage.

Upon establishing reported but unperformed medical activities, the NHIF will apply all sanctions provided by law, including the termination of contracts. In cases where evidence of violations exceeding the administrative scope of the Fund is found, the materials will be provided to the competent authorities, including the Prosecutor’s Office, to assess the presence of evidence of a crime.