New tools to fight against fraud EOPYY with her help Artificial Intelligence throws into the “battle” the Administration of the Organization. Through the use of anti fraud tools (AI) in the context of the Digital Transformation of the EOPYY that serves 11 million citizens and cooperates with more than 22,000 health care providers, “we try and emphasize how we will control the use of our resources, the money of insured, in real time, focusing on patient-centered service”, recently stated the Director of EOPYY Theano Karpodini.

In this direction, he added, multiple actions are being taken, such as the implementation of the electronic ticket at the EOPYY pharmacies, the electronic closing of the appointments of the insured, the intangible opinions. Also, all individual requests made by patients for various benefits such as reimbursement for optics, special education, patient transfers, dedicated nurses and various other requests to be made through the patient’s health insurance file within five minutes very easily, without moving the patient, without having to go to a regional address.

In 2024 EOPYY received approximately 33,000 complaints and to date over 23,000 have been closed. Most of them concern either a refusal to provide them with services, or additional charges that they ask for, prescription and execution of medicines and materials without their knowledge.

Beyond the financial dimension of the issue, a serious issue arises for the patient as a history of a condition that the patient does not have is included in his file. “An examination was prescribed which the patient did not take and when the patient then goes to e.g. to do an axial, the cutters that the Organization rightly has forbade him to do it”, said Ms. Carpodine.

The Organization undertakes to clear the patient’s file and immediately give him the possibility to unblock it AMKA of him and to be able to do his examination “or to take a drug that he now needs and it seems that he has taken 60 boxes, without his knowledge”, he noted.

The digital transition is at the forefront with the aim of improving the quality and efficiency of services. It includes real-time resource management, implementation of a digital platform to monitor pharmaceutical expenditure and develop performance indicators, ensuring timely interventions and cost-effectiveness. Also, expanding access and improving the quality of public health, expanding accessibility to services, upgrading public health standards and strengthening the sustainability of the NHS.

The Agency’s flagship actions include the extension from 2025 of the home delivery of High Cost Medicines to 120,000 patients, the establishment of Real Time checks in hospitals, the universal application of One Time Password (OTP), the preparation of financial statements and internal control.

With the mandatory use of OTP during execution, the physical presence of the beneficiary is confirmed when receiving the service or product. This reduces the possibility of over-invoicing or misleading claims for financial gain and ensures that available resources are used for the real needs of patients, improving the management of the health budget.

“We have implemented the unique verification code, OTP, in the categories where we have the highest delinquency, so that we can certify that the patient is there and the service was provided,” said Ms. Carpodine. In fact, by the end of January, the application will be completed, for the universal application and interface with the National Telecommunications Registry, so that each AMKA will have a unique certified contact number. During the issuance and execution of the prescription, the patient must give his consent for the procedure to proceed.

Another big change from 2025 will be in the way of costing hospitalizations and every service provided in public hospitals. It will be done with the new way of costing DRGs, where this “allows us to see beyond what the cost of a hospitalization contains, whether it’s materials, whether it’s medicine, whether it’s medical fees and anything else, who can more economically and more to effectively provide quality health services”, said the Director of EOPYY.