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ZMLUVA O POSKYTOVANÍ A ÚHRADE ZDRAVOTNEJ STAROSTLIVOSTI. II. ČASŤ


 | 20.9.2016 | komentárov: 228

Prinášame Vám pokračovanie príspevku, týkajúceho sa zmlúv o poskytovaní a úhrade zdravotnej starostlivosti. Materiálne zabezpečenie pri poskytovaní zdravotnej starostlivosti je nesmierne dôležité, a to nie len pre poskytovateľa zdravotnej starostlivosti. Úroveň zabezpečenia sa často prejaví na kvalite poskytovaných služieb, čo môžu pocítiť predovšetkým dotknutý pacienti.

Obrazok

Úhradu za konkrétne zdravotné služby poskytuje zdravotná poisťovňa a to na základe Zmluvy o poskytovaní a úhrade zdravotnej starostlivosti (ďalej aj Zmluva o poskytovaní), ktorá sa uzatvára medzi poisťovňou a poskytovateľom zdravotnej
starostlivosti. Takáto zmluva musí spĺňať zákonom stanovené náležitosti, ktoré majú zabezpečiť rovnaké podmienky pre všetkých pri poskytovaní zdravotnej starostlivosti a úhrade za zdravotnú starostlivosť. Popri samotnom procese, výsledkom ktorého je konsenzus medzi poisťovňou a poskytovateľom, je nesmierne dôležitá činnosť kontrolných orgánov, ktorých úlohou je dohliadať na správne a zákonné uzatváranie predmetných Zmlúv.

Prípad, kedy kontrolný orgán vykonal kontrolu v zdravotnej poisťovni sa uskutočnil aj začiatkom tohto roku. Kontrola bola vykonaná Najvyšším kontrolným úradom(ďalej aj NKÚ) a išlo o situáciu, kedy pri uzatváraní zmluvy neboli splnené všetky zákonom
stanovené podmienky. Predmet vyšetrovania predstavovali nápadne výhodné zmluvy uzavreté s niekoľkými poskytovateľmi zdravotnej starostlivosti. Medzi poskytovateľmi sa nachádzalo viacero lekární a niektoré právnické osoby poskytujúce rôzne
diagnostické vyšetrenia, ktorým bolo zo strany poisťovne poskytnutá viac ako nadštandardná úhrada za poskytované zdravotné služby.
Kontrola zmlúv vykonaná Najvyšším kontrolným úradom poukázala na neoprávnené zvýhodňovanie viacerých spoločností a na nedostatky v kompletnosti povinnej dokumentácie, potrebnej pre uzatvorenie zmlúv. NKÚ zistil, že poisťovňa uzavrela
niekoľko zmlúv, ktorých obsahom bolo oveľa viac výkonov, ako mohol poskytovateľ poskytnúť. Zistenia zároveň poukázali na poskytovateľov, ktorý vykázali o polovicu menej výkonov, ako mala v zmluve a zdravotná poisťovňa napriek tomu zazmluvnený
objem ponechávala na rovnakej úrovni.

V podobných prípadoch kedy NKÚ zistí porušenie povinnosti vyplávajúcich zo zákona, vydá odporúčanie, čo by kontrolovaný subjekt mal zmeniť, aby neporušoval zákon. Dôležité je, že NKÚ za konkrétne porušenie povinností, nemôže ukladať sankcie. Podľa
zákona č. 39/1993 Z. z. o Najvyššom kontrolnom úrade Slovenskej republiky, NKÚ môže udeliť sankciu len v jedinom jedinom prípade, a to ak uloží fyzickej osobe poriadkovú pokutu za neposkytnutie súčinnosti pri výkone kontroly. NKÚ nemôže udeliť sankciu
dokonca ani v prípade ak zistí, že kontrolovaný subjekt neplní opatrenia prijaté na odstránenie kontrolou zistených nedostatkov čo znamená, že kontrolovaný subjekt naďalej postupuje nezákonne. V takýchto prípadoch môže podľa uvedeného zákona
predložiť vec vláde. Ak vláda neprijme opatrenia na vyriešenie veci, predseda NKÚ predloží vec Národnej rade SR.  V prípade, že predmetné opatrenia neprijme ani Národná rada SR, nezákonný stav môže zostať aj bez zmeny. V dôsledku právnej úpravy,
ktorá neumožňuje NKÚ uložiť sankciu, sa výrazným spôsobom oslabuje postavenie tohto kontrolného orgánu a samotná kontrola stráca svoj pravý význam, spočívajúci v zamedzení ďalšieho protiprávneho postupu a v náprave do pôvodného zákonného
stavu.

Prirodzene, aj pri kontrole Zmlúv o poskytovaní a úhrade boli prijaté isté opatrenia adresované zdravotnej poisťovni. NKÚ na základe svojich zistení vydal odporúčania v rámci ktorých má poisťovňa zmeniť spôsob zverejňovania zmlúv a dodatkov na
svojom webovom portály tak, aby bol zrejmý zmluvný vzťah pri každom poskytovateľovi. Taktiež má byť zrejmé o akú zmluvu ide, či sú k nej dodatky a koľko poisťovňa aktuálne uhrádza. Zároveň odporúča, aby sa jednotlivé zmluvy dali vyhľadať na jednom mieste aj spolu s dodatkami. Uvedené odporúčania majú za úlohu napomôcť pri priebežnej kontrole zmlúv nie len zo strany kontrolných orgánov ale hlavne pri kontrole zo strany občanov. Kontrolou sa má zamedziť rôznym netransparentným zmluvám, ktoré by zvýhodňovali len istú skupinu
poskytovateľov zdravotnej starostlivosti a súčasne sa majú sprehľadniť procesy v oblasti uzatvárania zmlúv.

Popri Najvyššom kontrolnom úrade sa kontrolou predmetných zmlúv zaoberal aj Úrad pre dohľad nad zdravotnou starostlivosťou(ďalej len „Úrad“), ktorý vykonal v  poisťovni dohľad. Predmetom dohľadu bolo podobne ako pri kontrole NKÚ, dodržovanie
podmienok pri uzatváraní zmlúv o poskytovaní zdravotnej a lekárenskej starostlivosti a úhrada za zdravotnú starostlivosť.
Tu treba zdôrazniť rozdiel pri výkone kontroly uvedených kontrolných orgánov, ktorý spočíva v dôsledkoch pre kontrolovaný subjekt. Zatiaľ čo v prípade porušenia povinností subjektom, NKÚ príjme predmetné odporúčania, Úrad môže na základe zákona č.
581/2004 Z. z. o zdravotných poisťovniach, dohľade nad zdravotnou starostlivosťou a o zmene a doplnení niektorých zákonov, uložiť zdravotnej poisťovni pokutu a to až do výšky 165 969 eur.

Keďže kontrola vykonaná Úradom poukázala na pochybenia pri uzatváraní zmlúv, Úrad v tejto veci rovnako vyvodil určité dôsledky. V tomto smere treba zdôrazniť závery, ku ktorým Úrad dospel. Ich význam spočíva v pokute, ktorá bola štátnej poisťovni uložená
vôbec po prvý raz. Zároveň treba poukázať na výšku pokuty, tvoriacu sumu 75 tisíc eur, čo podľa nášho názoru nie je zanedbateľná čiastka. Na základe uvedeného sa preto domnievame, že práve skutočnosť, na základe ktorej bolo rozhodnuté o pokute pre
poisťovňu, ktorá zdravotnej poisťovni doposiaľ udelená nebola, má odrážať závažnosť konania, ktorého sa poisťovňa dopustila.

V závere je potrebné si položiť otázku, či za predmetné protiprávne konanie bude vyvodená zodpovednosť nie len na strane zdravotnej poisťovne ale aj na strane poskytovateľa, a či uvedené sankcie uložené poisťovni budú spĺňať svoju hlavnú úlohu,
ktorou je predchádzať podobným pochybeniam.




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