Report on the joint controls carried out
Report on controls carried out in private health institutions (PHI) – selected gynaecologists
The Health Insurance Fund of Macedonia has concluded contracts with a total of 149 private health institutions (PHI) for the provision of primary health care in the field of gynaecology (selected gynaecologists).
In November 2025, joint controls were carried out with the Public Revenue Office (PRO) in 49 PHI (33% of the total number of contracts). The controls were carried out due to frequent complaints from insured persons regarding the charging of funds for examinations that are not chargeable.
A joint control by the HIF and PRO was last carried out in 2012.
The purpose of the controls is to verify compliance with contractual obligations, especially with the provision that: “The examination, ultrasound, colposcopy, taking of a smear for microbiological and cytological testing (for PAP-test), as well as all other diagnostic and therapeutic procedures which are in accordance with evidence-based medicine at the selected doctor are not charged.”
Key findings – total
- Controlled PHI: 49
- Regular (without any irregularities either by HIFRNM or by PRO): 26 (53,1%)
- Irregular (overall – irregularities established by HIFRNM and/or PRO): 23 (46,9%)
- Only by HIFRNM: 3
- Only by PRO: 11
- By both institutions: 9
- Irregularities established at 12 PHI, main type of irregularity by HIFRNM: charging additional funds from insured persons (at 8 PHI) and irregular records (at 5 PHI), with penalties imposed
- Irregularities related to fiscalisation established by the PRO at 20 PHI, with fines imposed
Overview by cities/regions
|
City |
Contr. PHI |
Regular (overall) |
Irregular (overall) |
% Regular (overall) |
Irregular (HIFRNM) |
Irregular (PRO) |
|
Skopje |
16 |
7 |
9 |
43,8% |
5 |
8 |
|
Bitola |
7 |
5 |
2 |
71,4% |
1 |
1 |
|
Prilep |
7 |
5 |
2 |
71,4% |
2 |
1 |
|
Tetovo |
9 |
5 |
4 |
55,6% |
3 |
3 |
|
Shtip |
5 |
3 |
2 |
60,0% |
0 |
2 |
|
Strumica |
5 |
1 |
4 |
20,0% |
1 |
2 |
|
Total |
49 |
26 |
23 |
53,1% |
12 |
20 |
The controls carried out establish are significant from the aspect of protecting patients’ rights and compliance with the contractual obligations between the Fund and the PHI.
From a tax perspective, health services are exempt from VAT, and the largest part of these institutions pay a symbolic annual tax on total income of 1% or are fully exempt; this does not mean that non-recording of turnover has no tax effect. On the contrary, non-recording of income leaves room for its use as untaxed personal income, acquisition of personal property from untaxed income, as well as for cash payments for purchases that directly feed the grey economy. This practice undermines the system, creates an unfair advantage at the expense of those who operate legally, and in the broader context progressively leads to increased losses of public revenue.
