Chief prosecutor with the National Anti-corruption Directorate (DNA) Laura Codruta Kovesi on Monday underscored that solving corrupting in the healthcare system takes more than just arresting people or sending them to court, as more measures are needed that exceed the DNA powers.
“Over the past years, DNA has investigated both doctors and officials of the healthcare system. That proves us that solving corruption in the healthcare system takes more than just arresting people or sending them to court. More measures are needed that exceed the DNA powers,” Kovesi told a debate in Bucharest on Monday on corruption in the healthcare system – prevention and investigation; experience, good practices and challenges.
Asked about who should take such measures, Koevsi said all those responsible for prevention. “There is even an anti-corruption national strategy where the responsibility of each public organisation is spelled out.”
She said this was not the first time when the types of corruption offences in the healthcare system repeated themselves, which shows that some procedures have to change. At the same time, she said clearer and more urgent prevention measures should be taken.
Kovesi said the officials investigated and indicted for corruption should lose the public offices they use in commissioning criminal offences.
Bribing in healthcare system, higher than in other fields
Bribe levels in the healthcare system are higher than in other areas, with more than 75 people having been sent to court over the past years for corruption in this area, chief prosecutor with the National Anti-Corruption Directorate (DNA) Laura Codruta Kovesi said Monday.
”Investigating corruption in the healthcare system has been a priority with DNA. Ove the past two years, more than 75 people were sent to court over corruption in the healthcare area. (…) The types of offences investigated by DNA related to claiming, taking or giving cash, between 10 and 20 percent of the value of public procurement contracts. A specific component of the healthcare system investigations revealed that brining in the healthcare system is higher than in other areas. While, for instance, bribe size would be 10 percent of the contract value in construction and infrastructure, most of the healthcare public procurement contracts would regard bribe to the tune of 20 percent of the contract value,” said Kovesi.
She added that a high-ranking official with the Health Ministry, a director of the ministry, eight hospital managers of directors, one county council chair and then doctors were investigated and sent to court in 2015.
”One third of the county council chairs in Romania are sent to court by DNA over corruption or corruption-related offences, with some of them having been investigated in connection with healthcare procurement or funding services provided by companies directly or indirectly controlled by them. Our probes have revealed diversified types of corruption related to the healthcare system. Thus, the corruption offences detected by DNA regarded health care provisions, fraudulent issues of medical certificates or decisions, drug prescriptions, hiring to public hospital offices, approving market release for medicines, reimbursements of medical services or drugs by insurance companies, procurement of medicines and medicinal substances, medical equipment and devices, construction or refurbishing of hospital units, as well as conflicts of interest between those responsible with funding the system and those controlling healthcare companies,” said Kovesi.
In her opinion, corruption has a direct impact on everyone. ”In many instances, the amounts in bribe to functionaries are in their turn obtained fraudulently – from tax evasion, embezzlement or other offences generating material benefits. Thus, the additional costs incurred on business operators by corruption offences are reflected on the quality and price of their services. (…) The citizens are affected by medicine quality and the quality of medicinal products in hospitals when their procurement is done by bribe giving. The citizens pay higher prices when bribe is paid for the market release of medicines,”said Kovesi.
She added that bribe givers should be discouraged, along with the bribe takers.
Laura Codruta Kovesi also said on Monday that foreign companies are also involved in the widespread corruption in the healthcare system, and underscored the need for a strategic approach in the field.
”DNA’s ongoing investigations reveal that corruption is perpetrated in the same recurring manner. In the absence of clear prevention and control measures, the pattern of the investigated offences and the mechanisms that made them possible are repeated. A strategic approach for the prevention of corruption is required, especially when it comes to areas that directly affect the lives of citizens, such as healthcare,” Kovesi told a debate in Bucharest on corruption in the healthcare system – prevention and investigation; experience, good practices and challenges.
She cited the example of a DNA action last week that caught a county hospital manager red-handed while taking bribe for a public procurement contract; the same manger had been sent to court in 2014 for the same kind of offence. “Unless the investigative effort of law enforcement bodies is accompanied by preventive measures to change particular procedures, introduce management and control mechanisms, the citizens will further be affected,” said the DNA chief prosecutor.
Kovesi advocated the removal from office of the persons investigated and convicted for corruption.
”If those investigated and convicted for corruption are not kicked out the public offices they used to obtain illegal benefits, we will further have public servants receiving grease money to conclude public procurement contracts. Corruption in the healthcare system is the result of non-transparent spending of public money. As long as public procurement planning is not transparent, the budget will be further used for overpriced deals. Public money will be further used to buy expensive equipment from obscure companies while hospitals are unable to provide minimum care conditions for their patients,” added Kovesi.
According to the DNA head, investigations have revealed that sometimes the money offered as bribe are paid through accounts opened with foreign banks, most often into offshore accounts.
”Foreign companies are also involved in the corruption of the healthcare system, therefore holding the Romanian and foreign legal entities which handle the marketing of medicines and medical equipment criminally accountable is a priority for DNA. (…) It is important that we work on cases where we cooperate with organisational partners that also investigate the companies in question (…) and the exchange of information is essential,” said the DNA head.
PG Lazar: Common law prosecution offices solved 2,321 corruption cases in 2015
Common law prosecution offices solved 2,321 corruption cases in 2015, 318 of which involved court notifications, up 13 percent from 2014, Prosecutor General Augustin Lazar said on Monday.
“We are talking about 329 indictments and 59 pleas of guilty that led to 924 defendants being sent to court, along with 357 court notifications drawn up by the National Anti-Corruption Directorate (DNA), 13 of which regarded the healthcare system. Nationwide, 738 court cases were recorded that led to 2,182 defendants being sent to court over corruption and related offences,” Lazar told a debate on corruption in the healthcare system; prevention and investigation, experience, good practices and challenges held in Bucharest by DNA with support from the Dutch Embassy in Romania.
Lazar added that the 2014 and 2015 reports by the European Commission on Romania’s progress with judiciary reform and the fight against corruption under the Cooperation and Verification Mechanism (CVM) revealed areas where reforms got consolidated, and this trend was seen as a sign of advance in the durability direction.
“The judiciary overall continued to display professionalism, including adaptation skills to the new codes of law as well as the will to defend judiciary independence. The Public Prosecution Service will closely cooperate with its organisational partners in order to comply with all the CVM benchmarks,” said Lazar.
About judiciary independence, Lazar said merit-based appointment procedures will play a very important part this year, adding that the beginning augurs well and the DNA management is already stable.
”Integrity-based reform promotion has to continue. (…) We are very determined to reform the Public Prosecution Service so that European professionalism and mentality will set the tone and integrity will be the guiding principle for the system. It is very clear that the Public Prosecution Service needs reform and so does the judiciary overall, if we take a look at the small prosecution offices and courthouses scattered around the country that provide the greatest share of disciplinary problems and criminal offences in the system. The lawmaker needs to be convinced that the units have to be provided the right size, gathered in larger prosecution offices and courthouses led by experienced magistrates, with prosecutors under their coordination benefitting from improved organisational culture (…),” said Lazar.
Dutch ambassador Grubacic: Diluted disinfectants underscore urgency of corruption fight
Dutch ambassador in Bucharest Stella Ronner Grubacic said Monday that the urgency of the fight against corruption in the healthcare system is highlighted by the case of diluted disinfectants.
She told a debate on corruption in the healthcare system – prevention and investigation; experience, good practices and challenges that hundreds of hospitals acquired diluted and overpriced disinfectants from a local company, mentioning that one of the slogans at public protests after a fire at Colectiv club in Bucharest in 2015 was “Corruption kills!”
Grubacic underscored that the themes discussed on Monday, namely corruption in the healthcare system, can make the difference between life and death.
She added that there are no corruption-free countries, that corruption in the healthcare system is a reality in many countries, including in member states of the European Union, and that there are examples of improper conduct in the Netherlands as well.
Grubacic added that the biggest impact by far of corruption in the healthcare system is easy access to care for a few and hard access for many more as well as poor healthcare quality.
In her opinion, the development and implementation of practice standards and self-regulation by the healthcare system players could be good measures to fight against corruption.
She mentioned that citizens in the Netherlands are expected to have a part to play in this matter and they should be aware of the fine line between bribery and the expression of gratitude for doctors.
Competition head: Doctors prescribe more expensive medicines influenced by big budgets of pharma companies
Doctors in Romania are prescribing more expensive drugs influenced by the big marketing budgets of pharma companies, Chairman of the Competition Council Bogdan Chiritoiu told a 2015 activity report meeting on Monday. He added that the council will complete next week an inquiry into the drugs market. “What we have seen as part of this analysis is that surprisingly often more expensive medicines continue to be prescribed, the so-called innovative medicines, instead of less expensive generic drugs. Generally speaking, the additional efforts are borne by patients, so patients are the losers, because doctors prescribe and patients listen to doctors, which is normal. Doctors prescribe partly influenced also by the big marketing budgets of pharma companies. The chain would be: higher prices approved by the Government for the same medicines, which increase the money available to certain companies, which could use the additional funds to stimulate doctors prescribing the medicines,” said Chiritoiu. He added that all this leads to instances in which patients pay more than they should. “There are companies that lose because they pay a claw-back fee, a higher than necessary reduction, and patients also lose because they pay from their pockets more than they should,” said Chiritoiu. He added that he will discuss the matter with the healthcare officials when the council’s market analysis is over.