Eight brought in over eye surgeries: 3,000 to 4,000 patients, Health Fund loss of about €1.7 million

On October 29 the Ministry of Interior carried out an action with searches at several locations in Skopje and one each in Tetovo and Kumanovo, in a case of suspected double billing for eye surgeries. Eight people were brought in and 11 in total are suspects. All of them are only suspects, nothing has been proven in court and the presumption of innocence applies to everyone. The case was reported by Telma, Libertas, 360 Stepeni, Plusinfo, Racin and other outlets.

Who is a suspect? According to what Telma reported, the suspects include two former directors of the Health Insurance Fund, the chair of its Management Board, the director of the Control Sector, two female managers at the Fund, a foreign national and a legal entity. We do not name individuals, because there is no court decision. The two former directors are suspected of signing a contract in 2020 with a representative of the private clinic, contrary to the Fund’s procedures and acts.

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How, according to the Ministry, did the double billing work? False data was entered into the Fund’s electronic system and invoices with false content were issued. The clinic allegedly billed the same services to both the Fund and the patients. Patients paid the statutory co-payment and an additional private price for the operation, and were not told that the Fund was also paying.

What are the numbers? These are allegations by the Ministry, not established facts. Between 3,000 and 4,000 patients were allegedly charged twice. The damage to the Fund from fictitious invoices is about 104.8 million denars, or about €1.7 million. Another 525,000 denars are unpaid contractual penalties. The suspected unlawful gain is about 261.3 million denars, or about €4.25 million, for the period from 2022 to 2025.

What was found during the searches? According to Telma, €50,000 and mobile phones were seized.

What are the suspicions? The suspects are accused of abuse of official position and authority, negligent work in office, forgery or destruction of business records, fraud in office and money laundering.

What does the health minister say? Sašo Klekovski said he initiated the investigation while he was heading the Fund and that it has lasted more than a year. According to him, the clinic repeatedly broke the rules, so he proposed terminating its contract, and the commission accepted the proposal. Klekovski said the State Sanitary and Health Inspectorate and the Medicines Agency are also involved. Libertas and other outlets name the clinic as “Sante Plus”. Telma does not publish a statement from either the clinic or the public prosecution.

Who will return the money to patients? According to Racin, that question is open for now. No special refund procedure has been published. The amounts the Ministry cites are damage to the Fund and are not the same as the sum that may be owed to patients, which needs a separate check. It is therefore sensible for patients who had surgery to keep their receipts and medical records.

What comes next? The Ministry announced that it will provide more information once the operation is complete. Whether there will be an indictment is decided by the public prosecution, and guilt is determined by the court. Until then, the most important thing is to distinguish allegations from established facts.

MKNews Hub · Macedonia · October 30, 2026