Plovdiv Prosecutors Uncover Health Insurance Fraud Scheme: What the Investigation Revealed

Prosecutors in Plovdiv have uncovered a scheme involving 4,000 fictitious patients who were allegedly registered for non-existent medical examinations, hospital stays and rehabilitation treatments. The operation is said to have been organised by two doctors with the assistance of three relatives, all of whom have been arrested following a five-month investigation by Economic Police.

According to investigators, the estimated loss to the budgets of Bulgaria’s National Health Insurance Fund (NHIF) and National Social Security Institute (NSSI) amounts to nearly €500,000 for a single year alone.

The investigation began earlier this year when Economic Police in Plovdiv received intelligence about an organised criminal group recruiting individuals through Viber groups to participate in fictitious medical examinations.

The supposed patients were reportedly processed through three physiotherapy centres in Plovdiv and Asenovgrad, all managed by the same specialist physician.

Prosecutor Dimitar Pehlivanov of the Plovdiv District Prosecutor’s Office:

“These examinations, which are supposedly carried out by physiotherapists and rehabilitation specialists, are reimbursed by the Health Insurance Fund. This is the first stage of the damage to the public budget, because in reality such examinations were never performed.”

Investigators say that patients were subsequently provided with documentation enabling admission to specialised rehabilitation hospitals and sanatoriums, including facilities in the village of Banite.

Senior Commissioner Vasil Kostadinov, Director of the Plovdiv Regional Directorate of the Ministry of Interior, said that one of the facilities under investigation is located in the Smolyan region and that authorities are currently reviewing activities dating back one year.

photos by BTA

According to prosecutors, the financial damage extended far beyond the initial examinations.

“The loss to the budget from what I have described alone amounts to €500,000. But that is not all,” Pehlivanov said.

“After being referred to hospitals on the basis of fictitious diagnoses, the Health Insurance Fund again covers the cost of their stay, accommodation, meals and medical procedures. These procedures are reimbursed through clinical pathways, multiplying the financial damage several times over.”

The scheme allegedly continued with the involvement of an orthopaedic specialist from a hospital in Plovdiv, who is suspected of issuing at least 14 days of sick leave to many of the fictitious patients.

As an example, authorities cited a company employing Bulgarian workers abroad, whose staff reportedly requested and immediately received 20 sick-leave certificates.

The investigation has now expanded to include additional healthcare institutions.

Ivan Demerdzhiev:

“As you know, when we took office, the Prime Minister tasked us with identifying and combating the misuse of public resources.”

Authorities plan to interview all 4,000 individuals whose names appear in the documentation as having received treatment under the scheme.