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THE PROMOTION OF AN ANTI-FRAUD CULTURE

IN LITHUANIAN NATIONAL HEALTH INSURANCE FUND

Jurgita Šilinaitė-Šermukšnienė

Simona Adamkevičiūtė

LITHUANIAN NATIONAL HEALTH INSURANCE FUND

UNDER THE MINISTRY OF HEALTH

Berlin, 2019

WORKING GROUP ON THE FIGHT AGAINST FRAUD

THE CONTENT

• Corruption Perception Index

• Basic anti-corruption legislation in Lithuania

• Committee on corruption prevention in HIF

• The HIF Anti-Corruption Program: objectives and

measures

• Summary

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CORRUPTION PERCEPTION INDEX:LITHUANIA

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LITHUANIA – A LITTLE BELOW OF SCORE SCALE AVERAGE OF THE CPI OF WE AND EU

The Corruption Perceptions Index (CPI) is a measure of the country's perception of corruption by state and municipal officials and politicians. This index is based on business surveys and other expertstudies.

The CPI scores are on a 100-point scale where 100 points for a very transparent state and 0 for a very corrupt state. Experts emphasize that the perception of corruption in a particular country should befocused on the scores of the CPI, not on the list of countries. Both scores and position can be adjusted by changes in the research methodology as a whole.CPI is one of the world's most renowned corruption perceptions research, showing how countries around the world manage to control corruption.

LITHUANIA IN 2018: RANK 38/180, SCORE 59/100

LITHUANIA IN 2008: RANK 58/180, SCORE 4,6/10

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BASIC ANTI-CORRUPTION LEGISLATION IN LITHUANIA

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BASIC ANTI-CORRUPTION LEGISLATION IN LITHUANIA

The National Anti-Corruption Programand The Interinstitutional Action Plan

for the years 2015-2025

The Healthcare sector Anti-Corruption Program

for the years 2017–2019

The HIF Anti-CorruptionProgram

for the years2017–2019

WhistleblowerProtection Law

(in action since 1 January2019)

MoH

NHIF

Goverment

The law on balancing public and

private interests

CorruptionPrevention

Law

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BODIES AGAINST CORRUPTION/INSTITUTIONS FIGHTING CORRUPTION IN LITHUANIA

State Tax Inspectorate

• control of all taxpayers

Prosecutor‘s Office

• organized crime, corruption

Special Investigation

Service

• large-scale corruption

Financial Crime Investigation

Service

• criminal activities against the State financial system

All other public institutions

• participate in the national anti-corruption program according to their field of activity

Institutions and their fields of activity:

7COOPERATION NETWORK – ROUNDTABLE DISCUSSIONS

ROUNDTABLE DISCUSSION IN STATE TAX INSPECTORATE

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ENTITIES FOR PREVENTION OF CORRUPTION IN THE INSTITUTIONS

ONE SINGLE PERSONwith functions only for prevention activities*

*STATE TAX INSPECTORATE;MoH

DIVISION*

*THE SOCIAL INSURANCE FUND; HOSPITALS

SPECIAL COMMITTEEOF PERSONS WITH

DIFFERENT FUNCTIONS*

*HIF;DRUG CONTROL SERVICE

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COMMITTEE ON CORRUPTION PREVENTION IN HIF

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A POLICY OF INTOLERANCE FOR CORRUPTION IN

HIF

open to the public

encouraging the use of electronic services

do not tolerating the conflicts of public and private interest

following principles of selflessness, transparency and openness in their activities

do not tolerating any form of corruption and any kind of bribery or nepotism and misuse of duties

encouraging employees to deepen their knowledge of corruption prevention11

IN ORDER TO IMPLEMENT THE POLICY GOALS AND FEATURES OF ANTI-CORRUPTION PROGRAM IN THE HIF:

1) special Committee for Prevention of Corruption is

established:persons from different fields of activities

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2) one person from Personnel Administration Departmentfor monitoring the declaration of public and private interest

of employees is appointed

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THE COMMITTEE ON CORRUPTION PREVENTION:responsible for preparation of corruption-prevention program as well as for the monitoring and

coordinating of the implementation of the tasks of that program

Special activities of Committee to increase employee interest in anti-corruption:

Encouraging employees to participate in various anti-corruption initiatives

Consulting employees and accepting information about possible corruption

Distributing information related to the prevention of corruption to the employees and public

Organizing the commemorations of the International Anti-Corruption Day

Investigating complaints regarding corruption

Carries out preventive measures assigned to the commission, etc.

Organized the special quiz and the competition on creation of NHIF‘s anti-corruption symbol in 2017 13

Election of NHIF anti-corruption symbol

THE WINNER

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THE HIF ANTI-CORRUPTION PROGRAM: OBJECTIVES AND MEASURES

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THE HIF ANTI-CORRUPTION PROGRAM FOR THE YEAR 2017–2019

OBJECTIVES OF THE PROGRAM:

IMPROVE THE CORRUPTION

PREVENTION CONTROL

ENSURE TRANSPARENT AND OPEN PUBLIC

SERVICES

EVALUATE THE PROBABILITY OF

CORRUPTION OCCURRING

EDUCATE AND INFORM THE PUBLIC

TO DEVELOP ANTI-CORRUPTION

AWARENESS AND INTEGRITY OF EMPLOYEES

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ALL PROGRAM MEASURES ARE IMPLEMENTED BY:

Management board

(the director and his deputies, headsof departments and divisions)

All employees of the NHIF and THIFs are involved

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Main activities to implement objective:

• Rotation of commission members and leading person is foreseen

• A quarterly report on the implementation of the plan is prepared

• The effectiveness of the program annually is evaluated

IMPROVE THE

CORRUPTION PREVENTION

CONTROL

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Main activities in order to implement objective:IMPROVE THE TRANSPARENCY OF OPERATIONAL PROCEDURES AND

ENSURE TRANSPARENT AND OPEN PUBLIC SERVICES

• waiting list management for endo-prosthetics is fully automated

• waiting list management for dental prosthetics is fully automated

• residents can check by themselves what kind of healthcare services andprescriptions they have received through the e-government gates (IS) andthe amount paid from the CHIF budget for them. About 20,000 peoplecheck that information annually. About 7,000 more people apply to THIFfor such reports.

Transfer more HIFservices to

InformationSystems:

• CHIF budgeting principles

• NHIF financial data

• health care financial and statistical data

More and more data is being opened:

• of behavior in the event of a collision with corruption

• on whistleblower protection

• on gifting behaviour

HIF‘s legislation is being improved to ensure zero

tolerance for corruption among employees by setting rules: 19


Main activities in order to implement objective:

• anti-corruption evaluation of drafts of legal acts and ofalready valid legal acts is performed on the daily basis(examples of the types of legal acts that shall be evaluatedfrom an anti-corruption perspective: in publicprocurement, in human relation management andadministration fields, in the area of control of economicunits field)

• The probability of corruption in selected areas of activity is checked annually and risk elimination plan is prepared

CONDUCT AN EVALUATION

OF THE PROBABILITY

OF CORRUPTION

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The main questions in anonymous survey for employees are:

What kind of behaviour do they considered to be corruption?

Do they know how to behave if they faced with the corrupt practices at work?

Whether they considered health insurance funds as corrupt institutions

Which fields of activities of health insurance funds do they considered as the most corrupt?

Whether they have been ever offered a remuneration for a favourable decision,

Whether they themselves have given a bribe in the last calendar year et ctr.

Employees were asked to solve certain situations / tasks in order to find out if they recognize corrupt behaviour.

• The trainings for the employees are organised

• The NHIF annually carries out an anonymous survey in order to assess the change in intolerance to corruption of the employees

TO DEVELOP ANTI-

CORRUPTION AWARENESS

AND INTEGRITY OF EMPLOYEES

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• Ways of informing:• Announcements on Health Insurance Funds websites;

• media (press, radio, TV)

• On social networks: FB, Instagram, Flicr

• Leaflets, posters, information messages, educational videos on TV monitor in medical institutions

• Cooperation with non-governmental organizations is being developed

• Information in public transport

• Meetings with target groups – in order to inform about current issues

EDUCATE AND

INFORM THE

PUBLIC

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INFORMATION CONTENT FOR PUBLIC

1. Guarantees provided by Compulsory Health Insurance: free services, access to health care services funded from the CHIF budget, patients' rights and responsibilities, etc.

2. Reminders to the public not to pay for goods and services that hadalready been paid from the CHIF budget

3. Information that patients can check for themselves how much the CHIF budget has paid for their treatment

4. Guarantees provided by European Health Insurance Cards

5. Preventive health check-ups for children

ETC

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EXAMPLES OF INFORMATION DISCLOSURE:

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THERE IS FOLLOW-UP TO ALL THE ACTIVITIES FORESEEN

• A quarterly report on the implementation of the plan isprepared

• The ongoing corruption prevention program is continuous -every three years the program shall be updated in the light ofthe results

• The effectiveness of the program annually is evaluated: the effectiveness of the program is assessed on the basis of the annual employee survey results

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SUMMARY

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SUMMARY

TAKING PART IN INTERINSTITUTIONAL COOPERATION –ROUNDTABLE DISCUSSIONS;

RAISING EMPLOYEES AWARENESS IN THE FORM OFENTERTAINMENT;

EMPLOYEES AWARENESS MEASUREMENT – SURVEYS;

PROFESSIONALY PERFORMED INVESTIGATIONS FOR DETECTINGPROBABILITY OF CORRUPTION

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THANK YOU FOR YOUR ATTENTION

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