ASTANA, Kazakhstan — Kazakhstan’s Financial Monitoring Agency has uncovered large-scale fraud involving the country’s Mandatory Social Health Insurance (OSMS) system. Investigators say several medical organizations illegally received public funds for medical services that were never provided.
According to the agency, nearly 140,000 citizens were fraudulently registered with medical institutions, allowing clinics to claim unjustified reimbursements from the Social Health Insurance Fund.
Authorities are currently investigating 36 criminal cases, with preliminary estimates placing total losses to the state at more than 3.5 billion tenge.
One of the investigations involves officials of the Zhetysai Multidisciplinary District Hospital in the Turkistan Region. Investigators allege that OSMS funds were transferred to the bank accounts of more than 20 individual entrepreneurs who neither supplied goods nor provided any medical services.
The entrepreneurs reportedly had no contracts with the hospital, while their banking details were used to withdraw public funds and convert them into cash. The estimated damage in this case alone exceeds 501 million tenge. Two suspects have been taken into custody.
In Astana, the head of the private Forte Clinic was sentenced to five years in prison for organizing a scheme to illegally obtain money from the Social Health Insurance Fund. An employee of the National Scientific Center for Healthcare Development received a three-year prison sentence for unlawfully approving patient registration requests.
Investigators found that more than 15,000 people had been illegally registered with the clinic, while fake medical services worth 79 million tenge were entered into the Damu Med information system.
In the Almaty Region, the head of Mydental.kz and Dr. Nurzhanova Dentistry clinics was sentenced to four years in prison, with confiscation of property, after being convicted of fraud involving dental services.
According to investigators, no actual treatment was provided to patients. Instead, doctors’ accounts and the personal data of underage patients were used to create false medical records. More than 4,500 fictitious medical services were identified, causing an estimated 66 million tenge in losses to the state.
The Financial Monitoring Agency said efforts to combat fraud within Kazakhstan’s healthcare insurance system will continue, stressing that those responsible will be held accountable under the law.